肝内胆管内乳头状黏液性肿瘤MRI表现

目的探讨肝内胆管内乳头状黏液性肿瘤(IPMN-B)的MRI表现,提高术前诊断水平.方法回顾性分析经手术病理证实的19例IPMN-B的影像及临床资料,分析MRI表现,结合相关文献,确定IPMN-B分型.结果IPMN-B以Ⅲ型、Ⅳ型为主,其中Ⅲ型表现为胆管未显示明确肿瘤灶,胆管呈明显广泛扩张;Ⅳ型表现为胆管内肿瘤灶,伴有肿瘤上、下游胆管扩张.MRI表现为T2WI多呈等高信号,肿瘤信号高于肝实质,低于胆汁,MRCP显示部分患者胆管内"漂浮征"征象,增强扫描肿瘤多呈轻-中度强化.结论IPMN-B的MRI表现有一定的特征性,结合MRCP、DWI及MRI多期动态增强检查,有助于提高IPMN-B术前诊断的准确率,指导临床手术方案的制定.

Objective To investigate the magnetic resonance imaging(MRI)features of intrahepatic papillary mucinous neoplasm of the bile duct(IPMN-B)and to improve the preoperative diagnosis.Methods The imaging and clinical data of 19 cases of IPMN-B confirmed by surgery and pathology in our hospital were retrospectively analyzed,and the MRI findings were analyzed.Combined with relevant literature,the classification of IPMN-B was determined.Results The main types of IPMN-B were typeⅢand TypeⅣ.Among them,typeⅢshowed that the bile duct did not show a clear tumor focus,and the bile duct showed obvious extensive expansion.TypeⅣwas a tumor focus in the bile duct,accompanied by dilatation of the upstream and downstream bile ducts.MRI showed hyperintensity on T_(2)WI,and the tumor signal was higher than that of liver parenchyma and lower than that of bile.MRCP showed"floating sign"in bile duct of some patients,and the tumor showed mild to moderate enhancement on enhanced scan.Conclusion The MRI manifestations of IPMN-B have certain characteristics.Combined with MRCP,DWI and multi-phase dynamic contrast-enhanced MRI,it is helpful to improve the accuracy of preoperative diagnosis of IPMN-B and guide the formulation of clinical surgical plan.