肝门部胆管癌的MRI诊断

Magnetic resonance imaging diagnosis of hilar cholangiocar-cinoma

肝门部胆管癌是指原发于胆囊管开口与左右二级肝管起始部之间的胆管癌，亦称Klatskin瘤。肝脏MRI及MRCP检查是目前重要的影像学诊断方法。本文回顾性分析2010年10月至2012年10月第二军医大学附属长海医院收治的42例和第二军医大学附属东方肝胆外科医院收治的18例同时进行过MRI及MRCP检查的肝门部胆管癌患者的临床资料，将胆管癌按其大体病理特点基本可分为管壁浸润型、肿块型及腔内生长型3个类型，根据其术前影像学表现和术中及术后病理检查结果按Bismuth-Cor｜ette进行术前和术后分型。术前术后分型一致者35例，分型诊断符合率为89．7％（35／39）。同时术中及术后发现肝实质受侵犯19例（术前MRI检查发现16例），灵敏度为84．2％；血管受侵犯10例（术前MRI检查发现12例），灵敏度为83．3％；肝门部、腹膜后淋巴结转移6例（术前MRI检查发现4例），灵敏度为66．7％。MRI多技术多序列的联合应用，有利于肝门部胆管癌的诊断及鉴别诊断，对肿瘤的分期及治疗方案的制订具有重要的价值。

Hilar cholangiocarcinoma （ HCCA ） or Klatskin tumor is a scin＇hous adenocarcinoma that arises from the conjunction of bile duct and hepatic ducts. Hepatic magnetic resonance imaging （MRI） and magnetic resonance cholangio- pancreatogt＇aphy （MRCP） are important methods for the diagno- sis of HCCA. In this article, the clinical data of 42 patients in the Changhai Hospital and 18 patients in the Eastern Hepatobili- ary Surgery Hospital who received MRI and MRCP examination from October 2010 to October 2012 were retrospectively ana- lyzed. According to the pathological features, HCCA could be divided into mass-forming type, infiltrating type and intraductal type. Based on the results of imaging examination and intra- and postoperative pathological examination, Bismuth-Corlette types were decided pre- and postoperatively. The coincidence rate of pre- and postoperative Bismuth-Corlette types was 89.7% （35/39）.Infiltration of liver parenchyma was both detected pre- and post- operatively in 19 patients （16 patients were detected by MRI preoperatively）, and the sensitivity of MRI was 84.2% ; vascular invasion was both detected pre- and postoperatively in 10 patients （12 patients were detected by MRI preoperatively）, and the sensitivity of MRI was 83.3% ; hilar and retroperitoneal lymph node metastasis was both detected pre- and postoperatively in 6 patients （4 patients were detected by MRI preoperatively）, and the sensitivity of MRI was 66. 7%. Combined application of different sequences and techniques of MRI is helpful in the diag- nosis, staging and treatment of HCCA.