胆管导管内乳头状肿瘤的影像表现

Imaging features of intraductal papillary neoplasm of the bile duct

目的 探讨胆管导管内乳头状肿瘤（IPNB）的CT、MRI特征.方法 回顾性分析经活检或手术病理证实的38例IPNB患者的CT、MRI资料,21例行CT检查,17例行MR检查.分析IPNB肿瘤病灶结节或肿块的分布、胆管扩张、黏液等特征,并采用计量资料非参数检验比较证实含黏液的患者中,CT和MRI术前判断黏液及沿黏膜面生长准确性的差异.结果 38例中,发生于肝内胆管24例（单发5例、多发19例）,肝内及肝门部胆管多发病灶3例,肝门部胆管2例,胆总管8例,胆总管、胆囊管及胆囊多发病灶1例.在CT、MR图像上表现为扩张胆管内结节者分别为17、11例,表现为肝内囊性病灶伴囊内多发结节分别为4、5例.CT、MR强化特点表现为动脉期强化程度高于门静脉期、平衡期分别为18、12例.CT术前判断黏液准确性（30.0％,6/20）高于MRI（6.3％,1/16）,差异有统计学意义（Z值=2.58,P＜0.05）.术前CT判断位于黏膜面生长准确性（77.8％,14/18）低于MRI（92.6％,13/14）,差异有统计学意义（Z值=4.23,P＜0.01）.结论I PNB具有沿胆管黏膜面生长,扩张的胆管腔内结节或肿块等特征,CT、MRI对准确诊断IPNB具有一定价值.

Objective To investigate the CT and MRI features of intraductal papillary neoplasm of the bile duct （IPNB）.Methods Thirty eight patients with IPNB finally diagnosed by puncture biopsy or surgery were enrolled in this study.All the CT or MRI data were investigated retrospectively.Twenty one patients underwent CT examinations,17 patients underwent MRI examinations.The features of IPNB including the distribution features of the nodules or masses,CT and MRI features of cholangiectasis,mucus were analyzed.The accuracy differences of CT and MRI for the preoperatively diagnosing mucus and tumor growing along mucous were compared by nonparametric test.Results The lesions （including 5 patients with solitary lesions and 19 patients with multiple lesions） were located in intrahepatic bile duct in 24 patients,3 patients occurred simultaneously in intrahepatic and portal bile duct,2 lesions occurred in portal bile duct,8 lesions occurred in common bile duct,the lesions of 1 patient occurred simultaneously in common bile duct,cystic duct and gallbladder.Seventeen and 11 patients appeared nodules locating in dilated bile duct on CT and MRI,respectively.Four and 5 patients appeared cystic lesions with multiple nodules of the liver on CT and MRI,respectively.Higher contrast enhancement on CT and MRI in arterial phase than that in portal vein and equilibrium phase were observed in 18 and 12 patients,respectively.Excluding the patients undergoing puncture,CT was better than MRI in evaluating whether the mucus was present,with the accuracies of 30.0% （6/20） and 6.3% （1/16） for CT and M RI,respectively （Z =2.58,P 〈 0.05）.CT was worse than MRI in preoperatively evaluating the features of tumor growing along mucous,with the accuracies of 77.8% （14/18） and 92.6% （13/14） for CT and MRI,respectively （Z =4.23,P 〈 0.01）.Conclusion IPNB had the features of growing along mucous of the bile duct,nodule or mass in dilated bile duct and other features,CT and MRI are important in diagnosing the IPNB.