影像学对肝内胆管腺瘤的临床价值

The clinical value of imaging diagnosis in intrahepatic bile duct adenoma

目的提高对肝内胆管腺瘤（BDA）的认识。方法对我院收治的1例及文献报告的7例，共8例患者临床及影像学资料进行回顾性分析。结果8例中BDA肿块共10个（3个肿块1例，1个肿块7例），病灶大小0．4～80mm，肿块均位于肝脏表面，其中位于右肝6个，左肝4个；8例中伴胆管内瘤栓形成1例，伴囊肿1例，伴发肝癌3例。8例中行B超、CT及MRI检查3例，行CT、MRI检查2例，单独行B超检查1例，单独行CT检查2例，3例患者进行了血管造影检查。B超表现为结节状高回声1例，圆形或椭圆形低回声3例；CT平扫表现为低密度影，增强后早期和延迟期均有强化改变4例，平扫呈环状高密度影（钙化性胆管腺瘤），增强扫描表现为环状强化，延迟期强化更明显者1例；MRT T1W呈低信号，T2W呈高信号者3例，T1W、T2W均呈高或低信号者各1例；3例血管造影检查均显示肿瘤富血供及肿瘤染色改变。结论对位于近肝脏表面的小肿块，CT、MRI平扫加增强扫描对发现和鉴别BDA具有提示作用。

Objective To enhance the understanding of intrahepatic bile duct adenoma （BDA）. Methods The clinical data and imaging findings of 8 BDA cases were retrospectively reviewed, one from my own hospital and the other seven reported by literature. Results The 8 BDA cases which consisted of 5 men and 3 women with a mean age of 58.6 years; there were totally 10 masses （1 case with 3 masses, 7 cases with 1 mass）, ranging in size from 0.4 to 30 mm; all masses were located in the surface of the liver, 6 at right lobe of liver and 4 at left; 1 case involved with bile duct tumor embolus, 1 case with cyst and 3 cases with hepatic cancer. 3 cases underwent US, CT and MRI, 2 cases underwent CT and MRI, 1 case only underwent US, 2 cases only underwent CT, and 3 cases underwent hepatic angiography. US findings： 1 case presented hyper-echoic nodule, 3 cases showed round or elliptical hypo-echo. CT findings： 4 cases showed hypo-density on plain images, enhancment on early and delayed phase; 1 case showed circular hyper-density on plain images （calcified BDA）, circular enhancement on arterial and portal phase, and further enhancement on delayed phase. MRI findings： 3 cases showed hypo-intensity on T1WI, hyper-intensity on T2WI; 1 case showed hypo-intensity, and 1 case hyper-intensity, both on T1WI and T2WI. All the 3 angiographic cases proved the masses rich of blood supply. Conclusion The plain and enhanced scanning of CT and MRI is a cue to find and distinguish BDA from the little masses of superficial liver.