肝内肿块型胆管细胞癌CT强化模式及其病理基础

Intrahepatic Mass-forming Type Cholangiocarcinoma: CT Enhancement Patterns and the Related Pathological Basis

目的探讨肝内肿块型胆管细胞癌(IMCC)CT动态增强扫描不同特点及其组织病理学基础。资料与方法回顾性分析45例经病理证实的IMCC的CT平扫及动脉期、门静脉期、平衡期表现,将肿瘤CT强化特点与病理学结果进行对照。结果 45例中,22例单发病灶,23例多发病灶。动态强化表现为4种模式:①23例呈从周边向内部缓慢渐进性强化,病理上周边区肿瘤细胞丰富,中央区以纤维间质为主;②13例病灶整体均匀或不均匀缓慢强化,病理上肿瘤细胞较少,与纤维间质均匀混杂分布;③8例边缘轻度强化,内部不强化或散在灶状轻度强化,病理上周边区肿瘤细胞丰富,内部坏死明显,坏死中散在小灶状肿瘤细胞;④1例动脉期明显强化,平衡期强化轻度减退,病理上病灶内肿瘤细胞丰富,纤维间质稀少,两者分布均匀。结论 IMCC强化模式多样,强化类型与病理组织学密切相关。

Purpose To discuss different features of intrahepatic mass-forming type cholangiocarcinoma（IMCC） in dynamic enhanced CT scan and the related pathological basis.Materials and Methods Forty-five patients with IMCC confirmed pathologically underwent plain CT scan and enhanced CT scan during arterial phase,portal phase and equilibrium phase.The data were retrospectively analyzed,and the features on enhanced CT scan and the related pathological manifestations were further compared.Results For 45 cases,22 cases showed single lesion and the other 23 cases showed multiple lesions.Four kinds of patterns were shown on the basis of dynamic enhanced appearances：（1）23 cases showed slowly progressive enhancement from the periphery to internal areas,and the pathological results presented that the viable tumor cells were mainly located at the periphery while the central portion of the tumor was composed of abundant fibrosis and scanty tumor cells;（2）13 cases demonstrated homogeneous or inhomogeneous enhancement entirely and slowly,and the corresponding pathological results were featured by a few of scattered tumor cells and abundant fibrous stroma;（3）8 cases showed slightly peripheral enhancement,without internal enhancement or with slightly scattered enhancement,pathologically characterized by abundant tumor cells in peripheral areas,obvious coagulative necrosis in the center,and scattered focal tumor cells in the necrosis;（4）1 case had apparent arterial enhancement and slightly delay enhancement during equilibrium phase,the pathological results were characterized by rich tumor cells and scarce fibrous stroma,both were evenly distributed.Conclusion IMCC has various patterns on enhanced CT scan which are closely related to histopathological findings.