摘要
目的评价动脉期边缘强化的混合型肝癌(combined hepatocellular-cholangiocarcinoma,cHCC-CCA)和肝内胆管细胞癌(intrahepatic cholangiocarcinoma,ICC)的磁共振成像特征,以期在术前鉴别诊断方面提供一些参考。材料与方法共纳入了经病理证实的cHCC-CCA患者70例和ICC患者74例,所有患者的MRI增强检查均表现为动脉期边缘强化。回顾性分析cHCC-CCA和ICC患者的临床病理资料及MRI特征,比较cHCC-CCA和ICC患者的临床病理和MRI特征的差异。结果边缘强化的cHCC-CCA的肿瘤内出血(25.7%与9.5%,P=0.010)、非周边廓清(51.4%与9.5%,P<0.001)、强化包膜(60.0%与14.9%,P<0.001)、结中结征(7.1%与0%,P=0.025)及马赛克征(51.4%与2.7%,P<0.001)的发生率均显著高于ICC;相反,DWI序列的靶征(25.7%与52.7%,P=0.001)、延迟中央强化(38.6%与82.4%,P<0.001)及肝包膜回缩(31.4%与55.4%,P=0.004)的发生率均显著低于ICC。结论非周边廓清、强化包膜及结中结征、马赛克征等磁共振成像特征,结合AFP升高,将有助于鉴别动脉期边缘强化的cHCC-CCA和ICC。
Objective:To identify the MRI features of combined hepatocellular-cholangiocarcinoma(cHCC-CCA)and intrahepatic cholangiocarcinoma(ICC)with arterial rim enhancement,so as to provide some references for the preoperative differential diagnosis.Material and Methods:Seventy cHCC-CCA patients and 74 ICC patients confirmed by pathology were included in this study.Their contrast-enhanced MRI showed the arterial rim enhancement.The clinicopathological data and MRI characteristics of patients with cHCC-CCA and ICC were analyzed retrospectively.The differences of clinicopathological and MRI characteristics between cHCC-CCA and ICC patients were also compared.Results:In this study,the incidence of intratumoral hemorrhage(25.7%vs.9.5%,P=0.010),non-peripheral washout(51.4%vs.9.5%,P<0.001),enhancing capsule(60.0%vs.14.9%,P<0.001),nodule-in-nodule architecture(7.1%vs.0%,P=0.025),and mosaic architecture(51.4%vs.2.7%,P<0.001)in cHCC-CCA with arterial rim enhancement were significantly higher than those of ICC.In contrast,the prevalence of target sign on DWI sequence(25.7%vs.52.7%,P=0.001),delayed central enhancement(38.6%vs.82.4%,P<0.001)and hepatic capsule retraction(31.4%vs.55.4%,P=0.004)in cHCC-CCA were significantly lower than those of ICC.Conclusions:MRI features including non-peripheral washout,enhancing capsule,nodule-in-nodule architecture,and mosaic architecture,combined with elevated AFP,will be helpful to distinguish the cHCC-CCA with arterial rim enhancement from ICC.
作者
李祖坤
周长武
钱贤灵
曾蒙苏
杨春
路欣
LI Zukun;ZHOU Changwu;QIAN Xianling;ZENG Mengsu;YANG Chun;LU Xin(Department of Medical Imaging Center,People's Hospital of Luoping County,Yunnan Province,Qujing 655800,China;Department of Radiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
出处
《磁共振成像》
CAS
CSCD
北大核心
2021年第11期61-65,共5页
Chinese Journal of Magnetic Resonance Imaging
基金
国家自然科学基金(编号:91859107)。
关键词
混合型肝癌
肝内胆管细胞癌
磁共振成像
边缘强化
鉴别诊断
combined hepatocellular-cholangiocarcinoma
intrahepatic cholangiocarcinoma
magnetic resonance imaging
rim enhancement
differential diagnosis
