肿块型肝内胆管细胞癌CT和MRI影像学特征分析

Analysis of CT and MRI imaging characteristics of mass type intrahepatic cholangiocarcinoma

目的探讨肿块型肝内胆管细胞癌(MICC)的CT和MRI特征及其诊断价值。方法回顾性分析该院收治的52例经病理证实的MICC患者的影像资料,其中CT 38例,MRI 22例,兼行CT和MRI检查者8例。分别比较肿瘤的CT和MRI特征与病理结果之间的关系,判断其诊断准确率。结果CT或MRI增强扫描动脉期病灶主要表现环状强化,门脉期及平衡期进一步强化。主要伴随征象包括肝内胆管扩张,肝包膜凹陷,动脉血管穿行病灶。以病理诊断为金标准,CT和MRI联合诊断准确率为87.50%,高于单独运用CT(86.84%)或MRI(86.36%)。结论MICC具有特征性影像表现,动态增强扫描是CT、MRI诊断和鉴别诊断的要点,二者联合,并结合病灶的伴随征象(胆管扩张、包膜凹陷、动脉血管穿行)可进一步提高MICC的诊断准确率。

Objective To investigate the CT and MRI features of mass type intrahepatic cholangiocarcinoma(MICC)and their diagnostic value.Methods The imaging data of 52 patients with pathologically confirmed MICC admitted to the hospital were retrospectively analyzed,including 38 cases of CT,22 cases of MRI,and 8 cases of concurrent CT and MRI examinations.The relationships between CT and MRI features of tumors with the pathological results were compared,and the diagnostic accuracy was judged.Results In enhanced CT or MRI scans,the lesions in arterial phase were mainly manifested by the ring like enhancement,and further enhancement in portal phase and balance phase.The main concomitant signs included the dilatation of intrahepatic bile ducts,depressed hepatic capsule,and perforating lesions of arterial vessels.With the pathological diagnosis as the gold standard,the diagnostic accuracy of CT combined with MRI was 87.50%,which was higher than 86.84%of CT alone or 86.36%of MRI alone.Conclusion MICC has the characteristic imaging manifestations and dynamic contrast-enhanced scanning is the key point of CT and MRI diagnosis and differential diagnosis.Their combination and combining with the accompanying signs of the lesion(bile duct dilatation,capsular depression,arterial vascular penetration)can further improve the diagnostic accuracy of MICC.