胆管内生长型肝细胞癌的影像特征分析

Analysis to Imaging Features of Intraductal Hepatocellular Carcinoma

目的探讨胆管内生长型肝细胞癌的影像表现,以提高对该病的认识。方法回顾性分析经手术病理证实的4例(男3例,女1例)胆管内生长型肝细胞癌的临床、病理及影像资料。结果所有患者均行MRI平扫、磁共振胰胆管造影(MRCP)、CT平扫及CT增强扫描,其中2例行MRI增强检查,3例行二维超声,1例行超声造影检查。2例位于肝门部胆管,2例位于左或右肝管。CT平扫软组织密度4例;增强扫描动脉期轻度强化,门静脉期、延迟期强化减弱3例,动脉期中度强化、门静脉期明显强化1例。T1WI 3例稍低信号,1例低信号,;T2WI抑脂序列3例稍高信号,1例呈稍低信号;扩散加权成像(DWI)4例稍高信号。2例均动脉期边缘轻度强化,门静脉期、延迟期强化程度减弱。MRCP 2例肝门部截断,1例“软藤征”,1例局部充盈缺损,4例均有局部或全部肝内胆管扩张。2例二维超声示实性低回声,1例未检出,1例超声造影动脉期呈不均匀稍低强化,门静脉期对比剂稍退,延迟期呈稍低强化。结论胆管内生长型肝细胞癌的影像表现具有一定的特征性,其有助于该病的诊断、鉴别诊断及治疗方案的制定。

Objective To investigate the imaging features of intraductal hepatocellular carcinoma and to improve the understanding of the disease.Methods The clinical,pathological and imaging data of 4 cases(3 males and 1 female)with intraductal hepatocellular carcinoma confirmed by surgery and pathology were retrospectively analyzed.Results All patients underwent conventional MRI、MRCP,conventionalCTscan and CT scan with contrast,2 underwent MRI scan with contrastand 3 underwent two-dimensional ultrasound and 1 underwentcontrast-enhanced ultrasonography.2 cases were loca-ted at the hilar bile duct,and 2 cases were located at the left or right hepatic duct.On CT scan,All cases showed soft tissue density;3 cases showed mild enhancement in arterial phase,weakened in portal vein and equilibrium phases.1 case showed moderate enhancement in arterial phase,significantl enhancement in the portal venous phase.On T1WI,3 cases showed slighthypointensity and 1 cases showedhypointensity.On Fat suppression sequence image,3 cases showed slightl hyperinten-sity,1 case showed slightly hypointensity;On DWI,All cases showed slighthyperintensity.2 cases showed mild enhance-ment ofmargin of tumorin arterial phase,faded in the portal and delayed phases.On MRCP,2 cases had hepatic portal ob-struction sign,1 case hadsoft rattan sign,1 case had partial filling defect,.All cases had local or diffuse intrahepatic bile duct dilatation.On two-dimensional ultrasound,2 caseshowed solid hypoechoic,1 case showed no focus,1 case showed mild enhancement in arterial phase,weakened in portal and delayed phase.Conclusion The imaging manifestations of in-traductal hepatocellular carcinoma have certain characteristics,which contribute to the diagnosis,differential diagnosis and treatment of the disease.