肝细胞癌合并肝门部胆管癌栓与肝门部胆管癌的CT鉴别诊断

CT differential diagnosis of hepatocellular carcinoma with hilar cholangiocarcinoma thrombus and hilar cholangiocarcinoma

目的分析肝细胞癌(HCC)合并肝门部胆管癌栓(HBDTT)的CT影像特征,并探讨其与肝门部胆管癌(hilar CC)的CT鉴别诊断。方法收集中山大学附属第一医院及江门市新会中医院2013年1月至2018年12月经病理证实的HCC伴HBDTT患者42例(HBDTT组)及hilar CC患者51例(hilar CC组),对两组患者的临床资料及CT影像表现进行比较和分析。结果与hilar CC组相比,HBDTT组男性、乙型肝炎病史、上腹部疼痛比例较高,甲胎蛋白(AFP)水平升高更为常见,而hilar CC组CA19-9、癌胚抗原(CEA)升高患者更多(均P<0.05)。两组CT征象在是否同时累及肝实质及胆管、门静脉期“快退”、胆管壁增厚、血管癌栓及脾大等方面差异均有统计学意义(P<0.001),5项征象均具有较高的特异度(82.4%~98.0%),其中前3项诊断敏感度较高(100.0%、92.9%、85.7%)。结论利用CT可以对HCC合并HBDTT与hilar CC作出准确的鉴别诊断。病变同时累及肝实质和肝门部胆管、门静脉期“快退”及胆管壁不增厚是HCC伴HBDTT的特征性征象,结合乙型肝炎病毒感染、AFP水平升高等综合分析对鉴别HCC伴HBDTT与hilar CC有重要作用。

Objective To analyze the computed tomography(CT)characteristics of hepatocellular carcinoma(HCC)with hilar bile duct tumor thrombus(HBDTT)and to investigate the differential imaging features of hilar cholangiocarcinoma(hilar CC).Methods From January 2013 to December 2018,fourtytwo cases with pathologically proved HCC with HBDTT(HBDTT group)and fifty-one cases of hilar CCs(hilar CC group)from the First Affiliated Hospital of Sun Yat-sen University and Xinhui Traditional Chinese Medicine Hospital were retrospectively collected.The clinical features and CT findings between the two groups were compared and analyzed.Results Compared with hilar CC group,the proportion of male,hepatitis B history and upper abdominal pain were higher in HBDTT group,and increased alpha-fetoprotein(AFP)levels were common.However,there were more patients with elevated CA19-9 and carcinoembryonic antigen(CEA)in hilar CC group(P<0.05).On CT imaging characteristics,the presence of both parenchymal lesion with intraductal lesion,washout during the portal venous phase,thickened bile duct wall,intrahepatic vascular embolus,splenomegaly had significant differences between the two groups(P<0.001),all of these five characteristics showed high specificity(82.4%-98.0%),and the first three showed higher sensitivity(100.0%,92.9%,85.7%).Conclusions CT can be used for accurate differential diagnosis of HCC with HBDTT and hilar CC.The lesion involved both the liver parenchyma and hilar bile duct,washout during portal venous phase and without thickened bile duct wall are characteristic signs of HCC with HBDTT,which are important for the identification of HCC with HBDTT and hilar CC,when combined with hepatitis B virus infection and AFP levels.