肝细胞癌合并胆管癌栓的影像表现

目的 探讨胆管癌栓的影像表现,以提高影像诊断水平.方法 回顾性分析经手术病理证实的肝细胞癌(HCC)胆管癌栓13例患者资料,其中3例进行了CT和MR检查,2例仅行CT检查,8例仅行MR检查,7例进行了MR胰胆管成像检查,13例均进行了超声检查.采用四格表Fisher 确切概率检验方法比较超声与CT、MR诊断HCC胆管癌栓的准确性.结果 13例HCC肿瘤及胆管癌栓均在CT或MRI上显示.4例胆管癌栓在CT上表现为胆管内软组织块影,动脉期可见癌栓轻度增强,癌栓远端胆管扩张.11例胆管癌栓在T1 WI上均呈稍低信号,T2 WI为稍高信号,增强后可见轻、中度强化.MR胰胆管成像上胆管癌栓表现为:胆管阻塞中断、狭窄或不规则充盈缺损伴有梗阻上方胆管扩张,胆管突然截断或呈"鼠尾"状(5例);肝内胆管扩张,癌栓充满整个胆总管.胆总管不显示(2例).超声检查准确诊断胆管癌栓7例,误、漏诊6例.CT、MRI准确诊断12例,误诊4例,超声与CT、MRI诊断胆管癌栓差异无统计学意义(P=0.270).结论 CT或MRI对诊断HCC合并胆管癌栓及明确癌栓范围有价值.

Imaging manifestation of hepatocellular carcinoma With bile duct tumor thrombi

Objective To analyze the imaging features of hepatocellular carcinoma(HCC)with bile duct tumor thrombi.Methods Thirteen patients with bile duct tumor thrombi proved pathologically underwent imaging examination.MR and CT were performed in 3 cases,and 2 cases had CT only and 8 cases had MRI only.Uhrasonography(US)was performed in all 13 patients.The accuracy of bile duct tumor thrombi detection was compared between US.CT and MRI with Fisher tost.Results Liver tumors and bile duet tumor thrombi were demonstrated in all patients on CT or MRL Presence of intraluminal soft tissue mass was found in four of five cases on CT.and mild enhancement of the intraluminal mass in the arterial phase was noted.dilated bile duct distal to tumor thrombi was detected in all five patients.Eleven Tumor thrombi showed slight low signal intensity on T1 WI,slight high signal intensity on T2 WI,and mild to moderate contrast enhancement on the contrast-enhanced MR images.The MRCP findings of tumor thrombi were as follows:interruption,stricture of the bile ducts or irregular filling defect in the bile ducts with dilated intrahepatic ducts.bile duct was abruptly interrupted or showed a"rat-tail"stricture(n=5);the common bile duct was filled with tumor thrombi.intrahepatic bile duct dilatation and missing common bile duct was noted on MRCP(n=2).Bile duct tumor thrombi were toltecfly diagnosed in 7 cases on US,and 12 cases on CT or MRI.Six cases were misdiagnosed or miss-diagnosed on US,and 4 cases were misdiagnosed on CT or MRI.There was no significant difference between US and CT/MRI in diagnosis of bile duct tumor thrombi(P=0.270).Conclusion CT or MR imaging is useful for the diagnosis of HCC with biliary tumor thrombi and for evaluating the extension of thrombi.