囊性肝内胆管细胞癌与肝脓肿CT征象及鉴别诊断

CT features and differential diagnosis of cystic intrahepatic cholangiocellular carcinoma and liver abscess

目的:探讨囊性肝内胆管细胞癌与肝脓肿的CT征象及鉴别诊断。方法:搜集经临床穿刺及手术病理证实的21例囊性肝内胆管细胞癌(22个病灶)及26例肝脓肿的CT资料(29个病灶),并采用卡方检验对两组的常见形态征象进行分析。结果:靶征、分隔状强化征、边缘环形强化完整征及肿块缩小征在肝脓肿组的分布明显高于囊性肝内胆管细胞组(P<0.05)。边缘环形强化不完整征、向心性延迟强化征及肝被膜回缩征在囊性肝内胆管细胞组的分布明显高于肝脓肿组(P<0.05)。灌注异常在两组的出现率无明显差异。结论:囊性肝内胆管细胞癌与肝脓肿CT征象有相似之处,靶征、分隔状强化征、边缘环形强化完整征及肿块缩小征提示肝脓肿的可能性大,边缘环形强化不完整征、向心性延迟强化征及肝被膜回缩征提示囊性肝内胆管细胞癌的可能性大,对各个征象的详细分析和比较是鉴别诊断的重要依据。

Objective：To investigate the CT features and differential diagnosis of cystic intrahepatic cholangiocellular carcinoma and liver abscess. Methods：21 cases （22 lesions） of cystic intrahepatic cholangioceUular carcinoma and 26 cases （29 lesions） of liver abscess proved by clinical aspiration or operation and pathology were reviewed retrospectively. CT fea- tures of the lesions were analysed with SPSS software. Results：Target sign, septae enhancement,intact ring-like annular en- hancement and shrinkage of tumor size could be assessed more often in liver abscess, with significant statistic differences （P〈0.05） ;whereas incomplete annular enhancement, concentric delayed enhancement, retraction of liver capsule could be revealed more often in cystic intra-hepatic choiangiocellular carcinoma,with significant statistic differences （P〈0.05）. He paticn perfusion disorder had no significant differences between the two groups. Conclusion：CT features of cystic intrahepat- ic cholangiocellular carcinoma are sometimes confused with that of liver abscess. Target sign, septae enhancement,complete or intact annular enhancement, reduction of tumor size prompted to be the diagnosis of liver abscess. While incomplete annu- lar enbancement, concentric delayed enhancement,retraction of liver capsule prompted to be the diagnosis of cystic intrahe patic cholangiocellular carcinoma. Detailed comparison and analysis of every imaging feature will provide important evidence for differential diagnosis.