肝内胆管细胞癌与炎性病灶超声造影鉴别诊断价值

The effect of contrast enhanced ultrasound on differential diagnosis of intrahepatic cholangiocarcinoma and inflammatory lesions

目的探讨无肝硬化背景的肝内胆管细胞癌(intrahepatic cholangiocarcinoma,ICCC)与肝脏炎性病灶超声造影(contrast enhanced Ultrasound,CEUS)鉴别诊断要点。方法无肝炎病史及肝硬化背景、已行超声造影且经病理证实的25例肝内胆管细胞癌患者(男15例,女10例)及13例肝脏炎性病灶患者(男7例,女6例)为本研究对象,病灶中位大小4.9cm(范围1.8~11.4cm)。两组临床资料未见统计学差异。分析两组病例常规超声图像及CEUS灌注特征,探讨两种病变的鉴别诊断特征。结果病理确诊的ICCC病例中,超声造影后有2例(8%)误诊为炎性病灶,3例(12%)未能得出明确诊断;病理确诊的炎性病灶中,有1例(7.7%)误诊为肝内胆管细胞癌,1例(7.7%)未能得出明确诊断;动脉期ICCC表现为周边不规则环状高增强(48%,12/25)或片状强化(52%,13/25),炎性病灶多表现片状强化(84.6%,11/13),二者在动脉期均呈边界不清,形态不规则;开始廓清时间ICCC为(34.5±3.5)秒,炎性病灶为(62.7±12.6)秒(P=0.001)。利用时间-强度曲线,注射造影剂3分钟时肝实质强度与病灶强度差ICCC为10.5±4.7,炎性病灶为3.1±1.8(P=0.001),具有统计学差异。常规超声17例(68%)ICCC显示病灶周围胆管扩张,炎性病灶为1例(7.7%)。结论无肝硬化背景的肝内炎性病灶与ICCC的鉴别诊断需联合联合常规超声及CEUS信息,尤其需重视开始廓清时间及廓清程度。

Objective To investigate differential diagnosis value of contrast enhanced Ultrasound(CEUS) between intrahepatic cholangiocarcinoma(ICCC) and inflammatory lesions on patients without liver cirrhosis. Methods Twenty five ICCC patients(15 males and 10 females) and thirteen inflammatory patients(7 males and 6 females) who were diagnosed by histology were enrolled in this study. None of them were with hepatitis and alcoholic history. Lesions sizes were ranged from 1.8 to 11.4cm(medium size was 4.9cm). There was no significant difference on patients' clinical profiles between ICCC and inflammatory patients. Imaging features of the lesions on conventional ultrasound and CEUS were evaluated. Results After contrast enhanced ultrasound, among ICCC cases, two cases( 8%) were misdiagnosed as inflammatory lesions, three cases(12%) could not be made diagnosis. Among inflammatory cases, one case(7.7%) was misdiagnosed as ICCC and one case(7.7%) could not be made definite diagnosis. During arterial phase on CEUS, ICCC showed irregular peripheral ring enhancement(48%, 12/25) or enhancement with poorly defined margins( 52%, 13/25), while most inflammatory lesions showed enhancement with poorly defined margins(84.6%, 11/13). The time to start wash out was(34.5±3.5) s of ICCC and(62.7±12.6) s of inflammatory lesions(P = 0.001). According to time intensity curve, the intensity difference of lesion-parenchyma at 3 minutes after contrast agent injection was 10.5±4.7 in ICCC group, and 3.1±1.8 in inflammatory group(P = 0.001). Bile duct dilation around lesion under conventional ultrasound could be seen in seventeen ICCC cases(68%) and only one inflammatory case(7.7%). Conclusions The differential diagnosis of ICCC and inflammatory lesion in liver could combine information of CEUS and conventional ultrasound, especially the start time of wash out and the intensity difference of lesion-parenchyma.