动态增强CT和MRI在诊断肝周围性肿块型胆管细胞癌中的价值

The Diagnostic Value of Dynamic Contrast-enhanced CT and MRI in Intrahepatic Peripheral Mass-like Cholangiocarcinoma

目的探讨动态增强CT和MRI扫描在诊断肝内周围性肿块型胆管细胞癌中的临床价值。方法收集经手术病理证实、且有完整临床资料的肝内周围型胆管细胞癌的患者的临床和影像资料,纳入所有进行了动态CT增强(n=23)和MRI增强(n=19)扫描的患者资料进行分析。分别对病灶的大小、部位、边缘、形态、密度(或信号)以及动态增强表现以及继发征象进行分析。结果病灶均为单一肿块型36例,周围见卫星灶者6例;发生于右肝18例,左肝24例;肿瘤直径平均4.9±1.8cm(1.9-11cm)。平扫时,在CT上肿块均呈稍低密度,MRI上肿块呈稍高T2WI信号、稍低T1WI信号;动态增强时,23例CT扫描患者中,18例患者动脉期及门静脉期病灶周围见线样环状强化,延迟期均可见病灶中心不同程度延迟强化;19例MRI扫描患者中,13例患者动脉期及门静脉期病灶周围见线样环状强化,延迟期均可见病灶中心不同程度延迟强化。间接征象包括:周围性胆管扩张(n=17)、邻近肝包膜回缩(n=8)、肝门及腹膜后淋巴结肿大(n=16)。结论动态增强CT和MRI在肝周围性肿块型胆管细胞癌的诊断中具有重要的应用价值。

Objective To probe the diagnostic value of dynamic contrast-enhanced CT and MRI in the diagnosis of intrahepatic peripheral mass-like cholangiocarcinomas. Materials and Methods Dynamic contrast enhanced CT （n=22） and MRI （n=19） images in patients with pathologically conformed intrahepatic peripheral cholangiocarcinoma and detailed clinical information were retrospectively collected in this study. The lesions size, location, margin, morphology, attenuation（or signal） and contrast-enhanced imaging findings, as well as indirect imaging findings were reviewed. Results There were 36 solitary intrahepatic mass and 6 with peritumor satellite nodules. Of 42 cases, there were 18 masses located in the right lobe, and 24 in the left lobe. The tumors had a mean diameter of 4.9 ±1.8cm （1.9-11cm）. On non-enhancedscanning, all the masses demonstrated as slight hypo-attenuation on CT and slight hyper-intensity on T2WI and slight hypo-intensity on TlWI on MRI. On contrast-enhanced images, 18 of 23 CT cases showed peripheral rim-like enhancement in arterial phase and portal venous phase and intratumoral heterogeneous enhancement in all of the cases. While in 19 MRI cases, 13 cases showed peripheral rim-like enhancement in arterial phase and portal venous phase and intratumoral heterogeneous enhancement in all of the cases. Indirect imaging findings included peripheral intrahepatic bile duct dilatation （n=17）, adlacent liver capsule retraction （n=8）, and perihilar and retroperitoneal lymph node metastasis （n=16）. Conclusion Dynamic contrast-enhanced CT and MRI was useful tool in the diagnosis of intrahepatic peripheral mass-like cholangiocarcinoma.