肿块型肝内胆管细胞癌MRI影像诊断评价

发布时间：2018-05-18 08:27

本文选题：胆管细胞癌 + 磁共振成像　；参考：《福建医科大学》2014年硕士论文

【摘要】：目的：分析肿块型肝内胆管细胞癌(intrahepatic cholangiocarcinoma，ICC)的MRI表现，探讨MRI平扫、动态增强及DWI对ICC的诊断和鉴别诊断的临床价值。资料和方法：分析50例我院经病理证实的肝脏胆管细胞癌患者的MRI影像学资料，所有患者术前均应用PhilipsAchieva1.5T MR或Siemens Verio3.0T扫描仪进行常规的MR平扫、动态增强及DWI检查。观察、分析MRI平扫征象及动态增强各期病灶的强化特点，对ICC影像特点如病灶形态、信号、增强的强化方式以及有无胆管扩张、肝包膜皱缩、肝叶萎缩，血管受侵程度、是否出现肝门区、腹膜后淋巴结转移情况进行分析。测量病灶边缘部分即早期强化处、病灶中央延迟强化区域以及同组患者正常肝组织ADC值，进行统计分析。结果：(1)常规的MR平扫，，50例患者病灶均表现为不均匀或均匀的稍低T1、混杂T2信号，其中8例T2WI上病灶中心可见局灶性星芒状或片状低信号。（2）增强扫描，有25例病灶动脉期病灶边缘呈厚或薄环状、花环状强化，门脉期、延迟期对比剂逐渐向病灶内填充，强化范围增大，呈不均匀斑片状强化，部分呈网格状强化；19例病灶动脉期呈不均匀轻中度斑片状强化，延迟期强化范围增大，其中7例早期强化部分延迟期强化程度有所下降；4例病灶动脉期未见明显强化者，静脉期、延迟期病灶渐进性、向心性强化；有2例患者出现明显较均匀强化，延迟扫描强化程度轻度减退，仍呈相对高信号，病灶中央可见小斑点状低信号。（3）ICC的DWI呈不均匀稍高或高信号，肿瘤边缘部分即早期强化处、病灶中央延迟强化区域以及同组患者正常肝组织的ADC值分别（1.05±0.24）×10－３mm２/s、（1.56±0.28）×10－３mm２/s、（1.29±0.15）×10－３mm２/s，组间两两比较差异有统计学意义（P＜0.05）。结论：T2WI中心可见局灶性星芒状或片状低信号，增强扫描病灶周边早期强化部分在延迟时可出现强化程度减低，肿块周边早期强化部分DWI呈高信号，ADC值下降，这些特征征象对ICC的MRI影像定性诊断和鉴别诊断具有重要的参考价值。
[Abstract]:Objective: to analyze the MRI features of intrahepatic cholangiocarcinoma (ICC) and to explore the clinical value of MRI plain scan, dynamic enhancement and DWI in the diagnosis and differential diagnosis of ICC. Materials and methods: the MRI imaging data of 50 patients with pathologically proved hepatic cholangiocarcinoma in our hospital were analyzed. PhilipsAchieva1.5T Mr or Siemens Verio3.0T scanner was used to perform conventional Mr plain scan, dynamic contrast enhancement and DWI before operation. To observe and analyze the features of MRI plain scan and dynamic enhancement of the lesions at different stages, and to analyze the features of ICC, such as shape, signal, enhancement mode of enhancement and whether there were dilatation of bile duct, shrinkage of hepatic capsule, atrophy of hepatic lobe, and degree of vascular invasion. The presence of hepatic hilar area and retroperitoneal lymph node metastasis were analyzed. The ADC values of early enhancement, central delayed enhancement and normal liver tissue in the same group were measured and analyzed statistically. Results the lesions of 50 patients with conventional Mr plain scan showed heterogeneity or homogeneity of slightly lower T _ 1 and mixed T _ 2 signal intensity. In 8 cases, focal starchy or flaky hypointensity was observed in the center of the lesion on T2WI. In 25 cases, the margin of the lesion appeared as thick or thin annular, flower-like enhancement, portal phase, delayed phase contrast agent gradually filled into the focus, the range of enhancement was enlarged, and the enhancement was uneven and patchy. Among the 19 patients with partial reticular enhancement, the arterial phase was uneven, mild to moderate plaque enhancement, and the range of delayed enhancement was increased. In 7 cases, the degree of partial delayed enhancement was decreased in 7 cases, and in 4 cases, no obvious enhancement was found in the arterial phase of the lesion. In the venous phase, the focus in the delayed phase was progressive and concentric enhancement, and there were 2 patients with obvious homogeneous enhancement and slight decrease in the enhancement degree of delayed scanning, which still showed relatively high signal intensity. In the center of the lesion, the DWI of small speckled hypointensity. The DWI of ICC was uneven or hyperintense, and the marginal part of the tumor was the early enhancement. The ADC values of the central delayed enhancement area and the normal liver tissue of the same group were 1.05 卤0.24) 脳 10 -3 mm 2 / s (1.56 卤0.28) 脳 10 -3 mm 2 / s and 1.29 卤0.15 脳 10 -3 mm 2 / s respectively. There was significant difference between the two groups (P < 0.05). Conclusion the focal starlike or flaky hypointensity can be seen in the center of T2WI. The enhancement degree of the early enhancement part around the lesion may be decreased at the time of delay, and the DWI value of the early enhancement part around the mass is decreased with high signal intensity. These features have important reference value for MRI qualitative diagnosis and differential diagnosis of ICC.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.2;R735.8

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