肝内胆管乳头状瘤的CT及MR表现

CT and MRI findings of intrahepatic biliary papillomatosis

目的:探讨肝内胆管乳头状瘤(Intrahepatic biliary papillomatosis,IHBP)的临床病理特征、影像学表现。方法 :回顾性分析5例经手术病理证实的IHBP患者的临床病理特征及影像学表现,并结合文献进行分析和讨论。结果:5例IHBP患者中2例表现为间歇性黄疸、1例腹痛伴发热、1例左腰背部酸痛,1例体检时发现。影像学特点:5例均发现全胆管树系统扩张,胆总管下段无明确占位或结石,受累肝内胆管相对比另一肝叶胆管或胆总管不成比例的扩张,受累肝内胆管呈"瘤样"扩张,扩张的肝内胆管出现乳头状或长条状肿块影,MRCP示扩张胆管内多发乳头状及条状充盈缺损,3例位于右肝内胆管、2例位于左肝内胆管,肿块直径约0.3~2.5 cm,于CT平扫呈等或稍低密度,MR T1WI表现为等或稍低信号,T2WI上多呈等高信号,DWI上呈乳头状及条状高信号,增强扫描肿块呈轻度强化。结论:IHBP的影像学表现有一定的特征性,尤其MRCP、DWI及动态增强检查,熟悉该病的特征性影像学表现有助于对IHBP诊断及鉴别诊断。

Objective： To investigate the clinicopathological features and the imaging characteristics of intrahepatic biliary papillomatosis （IHBP）. Methods： Five patients with surgically and pathologically confirmed IHBP were included in the study. The imaging findings and pathological features were analyzed with the review of literature. Results： The clinical symptoms of these cases included intermittent obstructive janndice（2 cases）, abdominal pain and fever（l case）, and left upper quadrant pain （1 case）. One asymptomatic patient was detected during a routine examination. MRCP images showed dilatation of the entire biliary tree in all 5 cases. There was no mass or biliary stone in the distal common bile duct. When the tumor involved a segment or a hepatic lobe, the degree of bile duct dilatation was thus particularly severe and the involved bile ducts dilated cystically like an aneurysm. Multiple round, linear and papillary signal voids were presented within the lumen or attached at the wall of the bile duct on MRCP. Three cases located in the right intrahepatic bile duct, 2 in the left intrahepatic bile duct. The papillary tumors had a diameter range of 0.3 to 2.5 cm. The intraductal papillary tumors appeared as hypo- or isoattenuated soft tissue masses within the dilated duct compared with the hepatic parenchyma, and MRI images showed hypo- or isointense lesions on T^WI, hyper- or isointense lesions on T2WI, hyperintense linear or papillary lesions on DWI. The le- sions demonstrated slight enhancement on contrast enhanced imaging. Conclusion： The CT and MRI findings of IHBP can show some of its imaging characteristics, especially on MRCP, DWI and contrast enhanced images, which are helpful for its diagnosis and differential diagnosis.