原发性胆囊癌的MRI诊断价值探讨

Discussion on the value of MRI in diagnosis of primary gallbladder carcinoma

目的探讨MRI在原发性胆囊癌的诊断价值。方法回顾性分析经病理证实的28例原发性胆囊癌的MRI平扫及动态增强扫描完整影像资料。结果根据胆囊癌的临床分型,将本组胆囊癌分为3型:腔内结节型5例,厚壁型9例,肿块型14例。MRI表现:1腔内结节型,MRI显示胆囊形态正常或增大,肿瘤位于颈部者胆囊增大明显,结节性肿块由胆囊壁向腔内突出,基底可宽窄不一,边界清晰,增强扫描可见结节状软组织早期明显强化,MRCP可见胆囊形态不规则,有充盈缺损,或部分囊腔消失;2厚壁型,MRI上可见胆囊形态增大或正常,胆囊壁局限性或弥漫性不规则增厚,增强扫描显示增厚的胆囊壁明显不均匀强化,2例病灶可见肝门区淋巴结肿大。MRCP显示胆囊不规则,或部分显示;3肿块型,MRI可见胆囊区不规则肿块,胆囊腔被大部分或完全充填,原发病灶在T1WI上呈低信号,T2WI、STIR序列上病灶呈高信号,或混杂信号,增强扫描病灶呈不同程度强化,信号不均匀,MRCP显示多数胆囊不显影。其中有2例可见肝脏直接受侵润,胆囊附近肝脏内可见大片状不规则异常信号,强化与胆囊强化程度相仿。胆囊癌MRCP显示胆囊充盈缺损,肝内外胆管扩张,胆囊腔消失。结论 MRI平扫结合动态增强扫描对诊断原发性胆囊癌可显著提高诊断正确率。

Objective To discuss the diagnostic value of MRI in primary gallbladder. Methods MRI flat scan and dynamic enhanced scan of 28 cases of primary gallbladder carcinoma confirmed by pathology were retrospectively analyzed. Results According to clinical classification, gallbladder carcinoma were divided into 3 types： intracavitary nodular type in 5 cases, the thick wall type in 9 cases, mass in 14 cases. MRI： （1） Endovenous nodular type, MRI showed the cystic form is normal or increased, tumors located in the neck of gallbladder were increased obviously, nodular masses from the gallbladder wall to an intraluminal protrusion, a basal width, clear boundary, nodular soft-tissue was enhanced obviously by enhanced scanning in early stage. By MRCP, the morphology of the gallbladder is irregular, filling defect, or the disappearance of some cysts; （2） The thick wall type, MR1 visible morphological increased or normal gallbladder, gallbladder wall localized or diffuse irregular thickening,enhanced scan showed thickening of the gallbladder wall marked inhomogeneous enhancement, in 2 cases the lesion visible hilar lymph node enlargement. MRCP showed the gallbladder irregular, or part of a display; （~） The mass type, MRI visible gallbladder area irregular masses, cystic cavities are mostly or completely filling, primary lesions showed low signal on T1WI, T2WI, STIR sequences lesions showed a high signal, or mixed signal, enhanced lesions showed different level enhancement, signal is not uniform, MRCP showed the majority do not develop gallbladder. There were 2 visible liver directly affected by the invasion of liver, gallbladder near visible inside the big shape irregular abnormal signal, aggrandizement was similar to the gallbladder. Gallbladder carcinoma MRCP display gallbladder filling defect, intrahepatic and extrahepatic bile duct dilatation, gallbladder cavity. Conclusion MRI plat scan and dynamic enhanced scan in diagnosis of primary gallbladder carcinoma can significantly improve the diagnostic accuracy.