不同病理分级的肿块型肝内胆管细胞癌的影像学征象比较

Comparison of imaging features of intrahepatic cholangiocarcinoma with different pathological grading

目的:对比不同病理分级的肿块型肝内胆管细胞癌的影像学特征,以提高影像及临床认识。方法:回顾性搜集39例经手术病理证实的肿块型肝内胆管细胞癌,根据其病理分级不同将其分为高分化组(n=10)、中分化组(n=18)及低分化组(n=11)。对比分析3组影像学差异。结果:不同病理分级肿块型肝内胆管细胞癌均好发于肝左叶,在边缘、密度或信号均匀性,最大直径及伴随征象方面,组间比较差异无统计学意义(P>0.05);高分化组以类圆形肿块多见(8/10),低分化组以不规则多见(7/11),组间比较有统计学意义(P<0.05)。增强模式,高分化组以Ⅰ型及Ⅱ型强化为主(8/10),中分组以Ⅱ型为主(9/18),低分化组以Ⅲ及Ⅵ型为主(8/11),3组间比较有统计学意义(P<0.05);高分化组与低分化组强化模式,两两比较差异具有统计学意义(P<0.05)。结论:高分化型更容易表现为类圆形软组织肿块,强化模式多为Ⅰ型及Ⅱ型为主,低分化型常表现为不规则软组织肿块,强化模式多为Ⅲ型。

Objective：To discuss the imaging features of intrahepatic cholangiocarcinomas with different pathological grading and improve the diagnosis.Methods：Retrospective analysis of the MRI imaging features and pathological data of 39 cases of intrahepatic cholangiocarcinoma was performed.According to different pathological grading,all cases were divided in three groups：well-differentiated group（n=10）,moderately differentiated（n=18）and poorly differentiated group（n=11）.The imaging appearances were compared among the three groups.Results：There was no statistically significant difference among the groups in imaging features including predilection site,margin,uniformity,maximum diameter and accompanying signs（P〉0.05）.Well-differentiated intrahepatic cholangiocarcinoma more frequently presented as round mass（8/10,80.0%）,compared to 50.0%and 63.6%in moderately differentiated and poorly differentiated group（P〈0.05）.In high differentiation group,the tumor often showed typeⅠandⅡenhancement（8/10,80.0%）,compared to typeⅡenhancement in moderately differentiated group,typeⅢ and Ⅳ enhancement in poorly differentiated group.There was statistically significant difference among three groups in enhancement pattern（P〈0.05）.There was statistically significant difference between well-differentiated and poorly differentiated group（P〈0.05）.Conclusion：Well-differentiated intrahepatic cholangiocarcinoma more often shows round,well-defined mass and typeⅠand Ⅱ enhancement,compared to irregular mass and type Ⅲenhancement in poorly differentiated group.