MRI对胆囊癌的诊断价值

Diagnostic value of MRI in the carcinoma of gallbladder

目的探讨胆囊癌的MRI表现,提高胆囊癌的影像诊断水平。方法回顾性分析43例经病理证实为胆囊癌的MRI影像学资料。分析胆囊癌的形态、信号、强化特点、周围结构侵犯及转移情况,并与手术及病理对照。结果厚壁型12例,腔内型18例,肿块型13例。MRI信号T1WI为等、稍低信号,T2WI稍高、高信号,增强模式为持续或渐进性强化。20例肝内外胆管扩张,16例梗阻点位于肝总管。25例肝脏受侵,6例十二指肠受侵,4例网膜侵犯,3例胰腺侵犯。24例淋巴结转移,N1:9例,N2:15例。肝脏转移10例,均与病理诊断相符。根据MR的临床分期与手术分期符合率90.7%。结论 MRI能够清楚显示胆囊癌病灶,并能够准确地评价胆囊癌的周围结构侵犯及转移情况,能够准确进行临床分期,有助于制定治疗策略。

Objective To investigate the imaging features of gallbladder carcinoma in magnetic resonance imaging （MRI）, and to improve the diagnosis of the gallbladder carcinoma. Methods Forty three patients with pathological diagnosis of gallbladder carcinoma were studied with MRI. The MRI signs of the gallbladder carcinoma cases were analyzed and compared with the surgical and pathological findings. Results Twelve cases were wall-thickening type. Eighteen cases were intraluminal type. Thirteen cases were mass type. The lesions were slightly hypointense or isointense signal in T1WI, and slightly hyperintense or hyperintense signal in T2WI.The model of enhancement was progressive or continuous. There were twenty cases combined with dilated intra/extrahepatic bile duct. The obstruction level of the 16 cases were common hepatic duct. There were twenty five cases with directly invading adjacent liver parenchyma ,six involving duodenum ,four involving omentum and three involving pancreas. Twenty four cases had lymph node metastasis, including nine cases in N1 stage and fifteen cases in N2 stage. There were ten cases with liver metastasis, all of which were diagnosed correctly. The accuracy of clinical stages according to MRI findings was 90.7% compared with surgical stages. Conclusion MRI could clearly show the gallbladder carcinoma, and accurately evaluate the spread of invasion and metastasis. MRI is helpful to making exact clinical tumor stages, which is essential to making therapeutic option.