MRI动态增强结合MRCP技术在肝吸虫性胆管癌中的诊断价值

Diagnostic value of dynamic enhanced MRI and MRCP in cholangiocarcinoma caused by clonorchiasis

目的：探讨MRI动态增强结合磁共振胰胆管成像（MRCP）技术对肝吸虫性胆管癌的诊断价值及肝吸虫病与胆管癌的病理机制。方法：回顾性分析28例经手术或穿刺病理证实的肝吸虫性胆管癌的动态增强MRI与MRCP征象,包括肿瘤发生部位、大小、形态、信号特点、强化方式及胆管扩张特点。结果：1肿块型胆管癌：9例,表现为肝内圆形、类圆形或分叶状肿块,T1WI呈低信号或混杂信号,T2WI呈不均匀高信号,动态增强呈渐进式强化。2浸润型胆管癌：16例,表现为胆管内浸润性生长,T1WI呈低或等信号,T2WI呈不均匀高信号,动态增强呈渐进式强化。3腔内型胆管癌：3例,表现为病变区胆管腔内充盈缺损,T1WI呈低信号,T2WI呈稍高信号,Gd-DTPA动态增强呈全瘤较均匀强化。4MRCP：肿块型胆管癌表现为肿块周围肝内胆管轻~中度扩张合并肝内末梢胆管小囊状扩张;浸润型及腔内型胆管癌显示梗阻区远端胆管中~重度扩张。结论：肝吸虫感染是诱发胆管癌的重要因素,肝脏末梢胆管小囊状或杵状扩张为吸虫病较特异征象,MRI动态增强结合MRCP技术对肝吸虫性胆管癌的诊断具有重要价值。

Objective： To explore diagnostic value of dynamic enhanced MRI and MR cholangiopancreatography（MRCP） in cholangiocarcinoma caused by clonorchiasis and its possible pathogenesis. Methods： 28 patients with cholangiocarcinoma caused by clonorchiasis who were confirmed by surgery or pathology were enrolled in the study. Their MRI and MRCP fea- tures were retrospectively analyzed including the location, size, shape, signal intensity and enhancement pattern of the tumors, and the characteristics of bile duct dilatation. Results： There were 9 cases in mass-type, 16 cases in infiltrative-type and 3 cases in intracavitary-type. The MRI features of most tumors were hypointense on T1WI and inhomogeneouly hyperintense on T2WI. Tumors of mass-type and infiltrative-type showed gradual centripetal contrast enhancement. Tumors of intracavitary-type showed homogeneously enhanced filling defects in the bile ducts. On MRCP, the mass-type showed slight to moderate dilata- tion of intrahepatic biliary ducts around the tumors, with diffuse saccular dilatation of terminal intrahepatic bile ducts. The in- filtrative-type and intraeavitary-type showed moderate to severe dilatation of the biliary ducts. Conclusion： Clonorchiasis is an important cause for cholangiocarcinoma. The feature of elonorchiasis is saccular dilation of terminal intrahepatic bile ducts. Dynamic enhanced MRI with MRCP is an important technique for accurate diagnosis of eholangiocarcinomas caused by elonorchiasis.