Gd-EOB-DTPA增强磁共振成像在胆管癌诊断的应用

Application of Gd-EOB-DTPA-enhanced MRI in the diagnosis of cholangiocarcinoma

目的探讨不同类型胆管癌Gd-EOB-DTPA增强磁共振影像表现。方法回顾性分析25例经手术或穿刺病理证实的胆管癌的影像征象。每位患者均行T_1WI、T_2WI平扫、Gd-EOB-DTPA动态增强扫描、肝细胞期及胆管期扫描(CE-MRC)。从肿瘤形态、位置、胆管扩张程度、管壁增厚程度、信号强度、强化方式等各方面分析图像,并记录患者的血清总胆红素水平。结果①外生型胆管癌10例,表现为边界清楚的类圆形肿块,T_1WI呈低信号,T_2WI呈不均匀高信号,Gd-EOB-DTPA动态增强扫描呈渐进性强化,肝细胞期及胆管期呈不均匀低信号,CE-MRC可清晰显示胆道系统;②浸润型胆管癌10例,表现为胆管内浸润生长的肿块,T_1WI呈低或等信号,T_2WI呈不均匀稍高信号,Gd-EOB-DTPA动态增强扫描呈渐进性强化,肝细胞期及胆管期呈不均匀低信号,CE-MRC不能显示胆管系统;③息肉型胆管癌2例,表现为胆管内单发或多发息肉状肿块,T_1WI呈低信号,T_2WI呈稍高信号,Gd-EOB-DTPA动态增强扫描呈全瘤较均匀强化,肝细胞期及胆管期呈均匀低信号,CE-MRC延迟显影;④混合型胆管癌3例,同时具有2种或2种以上前述类型的表现。结论 Gd-EOB-DTPA增强磁共振可用于不同类型胆管癌的诊断与鉴别诊断,CE-MRC的成像效果受总胆红素水平影响,并与胆管癌类型存在一定关联。

Objective To describe the gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid （Gd-EOB-DTPA） - enhanced MRI appearance of cholangiocarcinoma. Methods MRI of 25 patients with pathologically-proven cholangiocarcinomas was reviewed. The MRI sequences included unenhanced T1- and T2-, and Gd-EOB-DTPA-enhanced Tl-weighted images in the arterial, venous, hepatocellular and biliary phases. The contour, location, signal intensities and enhancement patterns of the tumors, degree of bile duct dilatation and mural thickening were analyzed. The total serum bilirubin levels of all patients were also recorded. Results Both exophytic （10） and infiltrative （10） tumors showed gradual centripetal contrast enhancement in the arterial and venous phases and became hypointense in the hepatocellular and biliary phases. The polypoid tumors （2） were homogeneously enhanced in the arterial and venous phases, and hypointense in the hepatocellular phase. Three tumors had two or more of the contrast enhancement patterns. The biliary tree was clearly depicted in the biliary phase on 12 patients with normal bilirubin levels ≤22 μ mol/Land was obscured on 13 patients with elevated bilirubin 〉 22 μ mol/L. Conclusions Cholangiocarcinomas have variable appearance on Gd-EOB-DTPA- enhanced MRI. The biliary phase of Gd-EOB-DTPA-enhanced MRI reflects the biliary function.