摘要
目的:探讨富动脉血供肿块型肝内胆管细胞癌(IMCC)MRI特征及其病理基础。方法:回顾性分析2008年11月至2019年7月间丽水市中心医院经病理证实的IMCC患者首诊MRI资料。将肝内病灶在动脉期出现大面积明显强化的14例IMCC患者(14个病灶)纳入研究并分析病灶的影像特征,包括病灶一般情况、平扫和DWI信号表现、增强扫描强化表现及周围组织结构伴随征象。结果:富动脉血供IMCC多为结节或小肿块样,形态多较规则,边界均清晰;病灶在T1WI上呈较均匀的低信号;在T2WI及DWI上呈均匀或不均匀的高信号。强化表现共三型:I型共9(9/14)例,表现为动脉期整体或接近整体强化,增强后期持续稳定强化;II型4例(4/14),表现为动脉期厚环状强化,增强后期持续稳定强化;III型1例(1/14),表现为动脉期整体强化,门脉期快速廓清。7例(7/14)具有肝纤维化背景,6例(6/14)见动脉期瘤周一过性异常灌注强化,6例(6/14)可见延迟强化假包膜征。所有病例均未见明显脂肪变性、出血、胆管扩张及肝包膜凹陷。富动脉血供IMCC的病理特征是镜下肿瘤细胞分布密集含量多,同时可见丰富的血管裂隙;瘤内纤维间质分布疏松含量少,凝固性坏死及出血少见。结论:富动脉血供IMCC的MRI表现具有一定特征,可指导临床诊断。
Objective:To investigate the MRI features and pathology of intrahepatic mass-forming cholangiocarcinoma(IMCC)with rich arterial blood supply.Methods:A retrospective analysis was made of the initial-diagnosis MR data of IMCC patients pathologically confirmed in Lishui Central Hospital from November 2008 to July 2019.Totally 14 lesions(in 14 IMCC patients)showing extensive enhancement of arterial phase were included in the study,and their imaging characteristics,including the general condition of the lesion,the signal on plain scan and DWI,the enhancement pattern and accompanying signs of surrounding tissues were analyzed.Results:The MICC with rich arterial blood supply mostly demonstrated as nodule or small mass,with regular morphology and clear boundary;the T1WI was relatively uniform low signal;while the T2WI and DWI were uniform or uneven high signal.There were three enhancement patterns:Type I,9 cases(9/14),demonstrated whole or nearly whole enhancement in the arterial phase and continuously stable enhancement in the later period;Type II,4 cases(4/14),demonstrated thick ring-enhancement in the arterial phase and continuously stable enhancement in the later period;Type III,1 case(1/14),demonstrated overall enhancement in the arterial phase and quick washout in the portal venous phase.Otherwise,7 cases(7/14)had liver fibrosis background;6 cases(6/14)showed transient abnormal perfusion enhancement around the neoplasm in the arterial phase;6 cases(6/14)showed pseudocapsule with delayed enhancement.Overall,no cases showed obvious steatosis,hemorrhage,bile duct dilatation or hepatic envelope depression.Dense distribution of tumor cells,abundant vascular fissures,yet loose distribution of fibrous stroma,rare coagulation necrosis and hemorrhage were the pathological features of IMCC with rich arterial blood supply.Conclusion:IMCC with rich arterial blood supply demonstrated specific MRI features of its own,which is of clinical value.
作者
肖扬锐
毛卫波
李炳荣
王祖飞
XIAO Yangrui;MAO Weibo;LI Bingrong;WANG Zufei(Department of Radiology,Lishui Central Hospital,Lishui 323000,China;Department of Pathology,Lishui Central Hospital,Lishui 323000)
出处
《温州医科大学学报》
CAS
2020年第10期800-804,共5页
Journal of Wenzhou Medical University
基金
浙江省科技厅公益性项目(LGF18H220001)
浙江省医药卫生科技计划项目(2020KY1087)。
