肿块型肝内胆管细胞癌动态增强CT的典型与不典型征象分析

摘要

Objective To analyze the typical and atypical CT signs of mass-forming intrahepatic cholangiocarcinoma(MICC).Methods All the 17 cases of pathologically proved MICC cholangiocarcinoma underwent plain and dynamic enhanced CT examination.Combined with the pathological results,the CT scanning signs in every phases were analyzed.Results Of the 17 cases,totally 21 lesions were revealed,with the longest dimension ranged from 1.8cm to 5.3cm.Most MICCs showed heterogeneous low density on plain CT scan,and manifest blurred boundary with the liver parenchyma.Of the 21 lesions,15 MICCs(71%) showed typical rim or peripheral enhancement at arterial dominant phase with centripetal enhance in the delayed phases.6 cases of MICCs(29%) showed complete or nearly complete arterial enhancement and discharge on delayed phases,which revealed“fast in and fast out”pattern on the dynamic contrast enhancement CT scan.Capsular retraction of hepatic parenchyma was found in 5 cases,and biliary duct dilatation in 7 cases.Conclusion CT could diagnose MICC according to characteristic dynamic enhancement of the lesion,and analyze various proportions and distribution of the components within the lesions.%目的：分析肿块型肝内胆管细胞癌（mass-forming intrahepatic cholangiocarcinoma，MICC）动态增强CT的典型与不典型征象。方法17例经病理证实的MICC患者，均行平扫与动态增强CT检查，结合病理结果分析其CT扫描各期征象。结果17例患者共检出病灶21个，直径1.8～5.3cm。CT平扫上多数肿块表现为不均匀低密度，境界不清。15个病灶（71%）动态增强CT表现为典型的动脉期边缘强化、门脉期与延迟期肿块中央部分向心性强化；6个病灶（29%）表现为非典型的动脉期全部或部分强化，门脉期或延迟期肿块原强化区造影剂迅速流出，表现为“快进快出”。5例患者病灶邻近肝包膜凹陷，7例患者伴随胆管扩张。结论MICC的动态增强CT征象与病灶的生长方式及其内各组织成分的比例、分布相关。