肝内胆管囊腺癌的CT诊断及鉴别

CT Diagnosis and Differential Diagnosis of Intrahepatic Biliary Cysta-denocarcinoma

目的分析肝内胆管囊腺癌的CT表现,以提高诊断水平。方法回顾性分析7例经手术及病理证实的肝内胆管囊腺癌的CT资料。结果 7例均为单发囊性肿瘤,位于肝左叶4例,肝右叶2例,1例累及左、右叶。3例局限于肝内,4例突出肝外。肿瘤最大直径约(4.8-18.5)cm,2例单房类圆形,5例多房不规则分叶状。3例边界较清晰,4例局部边界不清。平扫囊壁均厚薄不均,6例见较明显壁结节,2例囊壁钙化。多房者囊内分隔粗细不一,2例巨大肿瘤囊内见较低密度实性成分。5例囊液密度不均,CT值约(11-29)HU,2例密度较均匀,CT值约(4-8)HU。增强7例囊壁、分隔动脉期轻度强化,门脉及延迟期呈持续不均匀中度强化;5例壁结节持续延迟强化,1例壁结节动脉期不均匀较明显强化,门脉及延迟期强化减弱。3例邻近肝内胆管轻度扩张,2例胆总管轻度扩张,1例腹腔及腹膜后多发淋巴结肿大,2例出现腹腔积液。结论肝内胆管囊腺癌的CT表现具有一定特征,认识其影像特征对诊断及鉴别诊断具有重要价值。

Objective To explore the CT characteristics of intrahepatic biliary cystadenocarcinoma and improve the diagnostic level.Methods Analyze he CT data of 7 cases of intrahepatic biliary cystadenocarcinoma which confirmed by surgery and pathology retrospectively.Results All of the 7 cases were single cystic tumors,4 cases in the left lobe of the liver,2 cases of the right lobe of the liver,and 1 cases involving the left and right leaves.3 cases were confined inside the liver while 4 cases were out of the hepatic outline.The maximum diameter of all tumors was 4.8 to 18.5 cm,2 cases were single cavity and with oval shape,5 cases were multiple cavities and showed irregular shape and with lobes.The boundary of 3 cases were clear while the rest 4 cases were unclear.The wall of the cystic wall of the lesion was uneven on unenhanced CT,the cystic wall of all 7 tumors were heterogeneous in thickness,obvious wall nodules can be seen in 6 tumors,spotted calcification of cystic wall can be seen in 2 tumors.The septum inside multiple cavities were heterogeneous in thickness,a little of solid tissue with mild low density can be seen in 2 cases of huge tumors.The cyst fluid of 5 tumors showed heterogeneous density and the CT value were 11-29HU while the rest 2 tumors showed uniform density and the CT value were 4-8HU.On enhanced CT,the cystic wall and septum showed mild enhancement in artery phase,and continued heterogeneous moderate enhancement in portal vein and delayed phase;the wall nodules of 5 cases showed delayed enhancement continuously,while the wall nodules of 1 tumor showed obvious enhancement unevenly in artery phase,and the enhancement decreed in portal vein and delayed phase.Adjacent intrahepatic biliary of 3 tumors showed mild enlargement,the common bile duct of 2 tumors showed mild enlargement,1 tumor accompanied with multiple swollen lymph nodes in the abdominal cavity and retroperitoneum,ascites can be seen in 2 tumors.Conclusion The CT features of intrahepatic biliary cystadenocarcinoma are of certain characteristics.It is of great value to recognize the imaging features for diagnosis and differential diagnosis.