MRI对肝内外胆管细胞癌的临床诊断价值

Application of MRI in the diagnosis of intrahepatic and extra-hepatic bile duct cell carcinoma

目的探讨不同部位胆管细胞癌的影像学特点,以提高对该病的认识及诊断准确性。方法回顾性分析经手术或穿刺病理证实的19例胆管细胞癌患者的MRI资料,其中肝内胆管细胞癌9例,肝门区胆管细胞癌8例,胆总管中下段胆管细胞癌2例,均行MRI平扫及增强扫描。结果肝内胆管细胞癌主要表现为结节状或类圆形肿块,边界不清,肿块周围见扩张的胆管包绕肿块,形成"胆管包绕征",肿块周围可见肝叶萎缩;肝门区胆管细胞癌主要表现为结节状、类圆形肿块,部分表现为胆管壁不规则增厚,左肝管、右肝管及肝总管可相互不连,肝内胆管明显扩张、增粗,形成"软藤征";胆总管中下段胆管细胞癌表现为类圆形肿块或管壁不规则增厚,胆总管下段呈鸟嘴样、刀切样狭窄、截断,肝内外胆管均扩张、增粗,形成"软藤征";肝内外胆管细胞癌的病灶强化方式都表现动脉期轻度强化,静脉期及延迟期呈渐进性延迟性强化。结论肝内外胆管细胞癌在MRI上的影像表现各有其特点及间接征象,MRI对软组织的分辨率高,运用MRI平扫及增强扫描可明显提高其检出率和诊断正确率。

Objective To study the imaging features of cholangiocarcinoma in different locations in order to improve the image diagnosis of the disease. Mathods MRI data were retrospectively collectedin 19 cases of cholangiocarcinoma confirmed by surgery or biopsy, both MRI plain scan and enhanced scan were performed in all patients. There were 9 cases of intrahepatic bile duct carcinoma, 8 cases of hilar cholangiocarcinoma and 2 cases in the middle and lower part of common bile duct. Results The intrahepatic bile duct cell carcinoma were characterized by nodular or circular masses, the boundary was not clear. The tumor was surrounded by a dilated bile duct, which forms the ‘bile duct wrap around＇ sign. The liver surrounding the lesion was atrophic. The hilar cholangiocarcinoma mainly showed nodular or round –liked masses, or irregular thickening of bile duct wall and lumen stenosis. The intrahepatic bile duct was dilated obviously showing soft rattan signs. The cholangiocarcinoma in the distal part of the common bile duct showed round mass or irregular wall thickening. The lumen of lesions was narrow or truncated like beak or knife, and intrahepatic bile duct and common bile duct proximal dilatation showing soft rattan signs. The enhancement pattern of the lesions showed mild enhancement in the arterial phase and progressive delayed enhancement in the venous phase and delayed phase. Conclusion The imaging features of intrahepatic and extra-hepatic bile duct carcinoma in MRI have their own characteristics and indirect signs. The imaging features of intrahepatic and extra-hepatic bile duct carcinoma in MRI have their own characteristics and indirect signs.The detection rate and diagnostic accuracy of disease can be improved by using MRI scanning.