混合型肝癌的CT表现及误诊分析

CT Characteristics and Misdiagnosis Analysis of Combined Hepatocellular Carcinoma and Cholangiocarcinoma

目的总结混合型肝癌的CT表现特征及其误诊原因,以提高诊断水平。方法回顾2009年1月-2015年2月经手术后病理证实的7例混合型肝癌患者的CT资料,就病变部位、形态、大小、密度、边缘、强化特点、病变毗邻血管及胆管侵犯、淋巴结肿大、肝硬化、腹腔积液等表现进行分析讨论。结果 7例混合型肝癌共7个癌灶。平扫均呈稍低密度结节或肿块。增强后动脉期可见5个明显不均匀强化,2个边缘轻度强化。门静脉期及延迟期,癌灶部分区域强化程度明显减低,部分区域持续性环形或结节、斑片状强化。7例中门静脉受侵2例,胆管受侵1例,腹腔淋巴结转移2例,肝硬化1例,腹腔积液1例。术前仅2例CT正确诊断,其余5例均误诊。结论混合型肝癌在CT增强检查中有一定特征性表现,仔细分析其CT特征表现,并结合临床症状、实验室检查等资料可作出定性诊断,减少误诊。

Objective To discuss the CT characteristics of combined hepatocellular carcinoma and cholangiocarcinoma （cHCC-CC）, and analyze the reasons for its misdiagnosis. Methods We retrospectively analyzed the CT data of 7 patients diagnosed to have combined hepatocellular carcinoma and cholangiocarcinoma by postoperative pathological analysis between January 2009 and February 2015. We analyzed such characteristics as location, shape, density, enhanced features, surrounding invasion, mediastinal lymph node metastasis, cirrhosis and pyoperitoneum of the disease. Results There were 7 tumors among the 7 patients. Plain scan showed slightly lower density nodules or masses. After the enhancement of arterial phase, 5 tumors showed obvious inhomogeueous enhancement but 2 mild marginal enhancement. During the portal venous phase and the delay stage, the regional degree of tumor loci was significantly decreased, but some regions sustained annular or nodular and patchy enhancement. Among the 7 cases, the portal vein was invaded in 2, bile duct in 1, lymph node metastasis in 2, cirrhosis in 1, and peritoneal effusion in 1. Preoperative diagnosis was correct in only 2 cases and the other 5 cases were misdiagnosed by CT. Conclusions The cHCC-CC possesses some characteristic appearances on CT. Analyzing the characteristics carefully combining with symptom and cytological examination of hydrothorax can reduce the incidence of misdiagnosis.