肝内胆管囊腺瘤和囊腺癌的MRI鉴别诊断

目的分析肝内胆管囊腺瘤和囊腺癌之间的MRI表现差异,以提高对两种疾病的诊断准确率。方法分析经病理证实的24例囊腺瘤及10例囊腺癌患者的MRI表现,包括肿瘤部位、大小、瘤周胆管扩张,囊壁结节和强化方式等征象,并进行数据分析。结果24例囊腺瘤中单囊型5例,多囊型19例,多囊型病灶内有分隔,分隔菲薄且均匀;囊壁平均厚度(1.7±0.5)mm,伴瘤周胆管轻度扩张8例;增强后囊壁及囊隔中度强化5例,轻度强化19例。10例囊腺癌中单囊型6例,多囊型4例;10例均见囊壁不同程度增厚,平均厚度(2.2±0.7)mm;9例病灶囊壁见菜花状结节,伴瘤周胆管扩张8例;增强后囊壁中度强化8例,轻度强化2例。结论囊腺瘤和囊腺癌的分房、大小,瘤周胆管扩张,囊壁厚度,囊壁结节和强化方式的差异有统计学意义,MRI扫描及结合MRCP有助于诊断与鉴别诊断。

Objective To analyze the differences in magnetic resonance imaging(MRI)findings between intrahepatic biliary cystadenoma and cystadenocarcinoma,and to improve diagnostic accuracy of the two diseases.Methods The MRI findings of 24 cases of intrahepatic biliary cystadenoma and 10 cases of cystadenocarcinoma confirmed by pathology were analyzed.Signs included tumour location,size and peripheral bile duct dilatation,wall nodule and enhancement pattern,and the data was analyzed.Results Among the 24 cases of intrahepatic biliary cystadenoma,5 cases were monocystic and 19 cases were polycystic.The polycystic lesions had septa that were thin and uniform,the average thickness of the cyst wall was(1.7±0.5)mm,with mild dilation of the peripheral bile duct in 8 cases.After enhancement,the cyst wall and septum were moderately enhanced in 5 cases,with mild enhancement of 19 cases.Among the 10 cases of cystadenocarcinoma,6 cases were monocystic and 4 cases were polycystic,all 10 cases showed different degree thickening of cyst walls,and the average thickness was(2.2±0.7)mm,cauliflower-like nodules were seen in the cyst wall of the lesions in 9 cases,with 8 cases of peripheral bile duct dilatation.After enhancement,the cyst wall was moderately enhanced in 8 cases and mildly enhanced in 2 cases.Conclusion The staging,tumor size,peripheral bile duct dilatation,cyst wall thickness,wall nodule and enhancement pattern of cystadenoma and cystadenocarcinoma are different.The differences are statistically significant.MRI scans combined with magnetic resonance cholangiopancreatography(MRCP)are helpful in diagnosis and differential diagnosis.