MRI联合序列检查在肝门及肝外大胆管癌诊断和亚型鉴别中的价值探讨

Clinical Value of MRI United-sequences Examination in Diagnosis and Differentiation of Morphological Sub-type of Hilar and Extrahepatic Big Bile Duct Cholangiocarcinoma

中文关键词:  胆管癌 分型 磁共振胆管造影术 磁共振

英文关键词:Cholangiocarcinoma Morphological type MR cholangiography MRI

中文摘要:

      目的 分析不同亚型肝门、肝外大胆管癌的磁共振成像（MRI）表现及相关组织病理学基础，探讨结节型（NCC）及管内生长型（IDCC）肿瘤的鉴别。方法 回顾性分析152例经手术病理证实且MRI检查序列完整肝门及肝外大胆管癌患者的影像学资料，包括管周浸润型（PDCC）86例、NCC 55例、IDCC 11例。观察分析3种不同亚型肿瘤的影像学表现。结果 PDCC、NCC、IDCC这3种亚型大胆管癌均有独特的影像学表现。NCC与IDCC亚型在肿瘤形态、强化模式及平衡期强化程度，肿瘤单或多发，肿瘤部位胆管壁、胆管腔的改变，肿瘤近端、远端胆管是否扩张，肿瘤是否侵犯邻近结构等方面的差异具有统计学意义（P<0.05）。结论 不同亚型肝门及肝外大胆管癌的影像学表现与其生长模式密切相关，MRI联合序列检查能准确描述不同亚型肿瘤的影像学特点，综合分析其MRI表现可以准确诊断并鉴别其形态学亚型。

英文摘要:

      Objective To investigate MRI features and associated histological and pathological changes of hilar and extrahepatic big bile duct cholangiocarcinoma with different morphological sub-types, and its value in differentiating between nodular cholangiocarcinoma(NCC) and intraductal growing cholangiocarcinoma(IDCC). Methods Imaging data of 152 patients with pathologically confirmed hilar and extrahepatic big bile duct cholangiocarcinoma were reviewed, which included 86 periductal infiltrating cholangiocarcinoma (PDCC), 55 NCC, and 11 IDCC. Imaging features of the three morphological sub-types were compared. Results Each of the sub-types demonstrated its unique imaging features. Significant differences (P<0.05) were found between NCC and IDCC in tumor shape, dynamic enhanced pattern, enhancement degree during equilibrium phase, multiplicity or singleness of tumor, changes in wall and lumen of bile duct at the tumor-bearing segment, dilatation of tumor upstream or downstream bile duct, and invasion of adjacent organs. Conclusion Imaging features reveal tumor growth patterns of hilar and extrahepatic big bile duct cholangiocarcinoma. MRI united-sequences examination can accurately describe those imaging features for differentiation diagnosis.