肝内胆管乳头状瘤的CT及MRI表现特征
CT and MRI features of intrahepatic bile duct papilloma
李洁 1张燕绒 1郑瑶瑶 1谢品楠 2王以巧 3邱乾德4
作者信息
- 1. 浙江省乐清市人民医院放射科,乐清 325600
- 2. 浙江省永嘉县人民医院放射科,永嘉 325100
- 3. 浙江省乐清市人民医院肝胆外科,乐清 325600
- 4. 浙江省温州市人民医院影像科,温州 325000
- 折叠
摘要
目的 探讨肝内胆管乳头状瘤(IHBP)患者的CT与磁共振成像(MRI)表现特征.方法 回顾性分析2012年1月至2021年12月在浙江省乐清市人民医院和浙江省永嘉县人民医院经手术后病理确诊的18例IHBP患者的临床资料,其中男性10例,女性8例,年龄(61.1±8.2)岁,年龄范围26～83岁.收集患者的CT和/或MRI资料,记录患者的性别、年龄、合并疾病情况、肝内胆管扩张情况、胆总管扩张情况、胆管扩张分型等资料.采取来院门诊复查及电话相结合的方式随访.结果 18例患者中,12例行CT+MRI,4例仅行CT检查,2例仅行MRI检查.18例患者中,肿瘤位于肝左叶胆管14例,肝右叶胆管2例,肝尾叶胆管1例,肝左右叶交界处胆管1例.肿瘤长径2.8(2.7,2.9)cm,范围1.5～25.6 cm,肿瘤均呈囊实性,11例呈多囊状,7例呈单囊状.肿瘤部位的胆管"瘤样"扩张,扩张的胆管内见乳头状、花瓣状及结节状病灶,其中病灶与胆管壁相连13例,病灶与胆管壁间见有液性间隙5例.CT平扫示肿瘤呈囊实性,囊性部分呈均匀低密度;实性病灶密度均匀8例,不均匀8例;扩张的胆管内乳头状、花瓣状及结节状病灶呈低密度11例,等密度5例.CT增强后动脉期见实性病灶、间隔及囊壁轻、中度强化3例,仅见纤细强化血管13例;门脉期病灶持续轻度强化4例,未见进一步强化12例;延迟期强化程度降低.MRI平扫显示肿瘤囊实性,囊性部分T1加权成像(T1WI)呈均匀低信号,T2加权成像(T2WI)和弥散加权成像(DWI)呈均匀高信号.实性病灶、间隔及囊壁T1 WI呈等或稍低信号,T2WI上呈等、高信号,DWI上呈乳头状或条状高信号.MRI增强后动脉期实性病灶、间隔及囊壁轻度、中度强化4例,仅见纤细强化血管10例;门脉期持续轻度强化5例,未见进一步强化9例;延迟期持续轻度强化4例,强化程度降低10例.结论 IHBP多见于肝左叶,CT和MRI均显示胆管内病灶呈乳头状、花瓣状及结节状,病灶部位胆管呈"瘤样"扩张.实性病灶CT显示均匀或不均匀低密度和等密度,实性病灶MRI于T1WI显示等或低信号,T2WI和DWI呈等或高信号,CT和MRI增强后均示实性病灶、间隔及囊壁持续不均匀轻、中度强化.
Abstract
Objective To investigate the CT and magnetic resonance imaging(MRI)features of intrahepatic bile duct papillomatosis(IHBP).Methods A retrospective analysis of clinical data of 18 patients with IHBP diagnosed by postoperative pathology at Yueqing Peoples Hospital and Yongjia Peoples Hospital in Zhejiang Province from January 2012 to December 2021,including 10 males and 8 females,aged(61.1±8.2)years old,ranging from 26 to 83 years old.CT and/or MRI data of patients were collected,meanwhile recording their gender,age,comorbidities,intrahepatic bile duct dilation,common bile duct dilation,and bile duct dilation classification.Follow up was conducted through a combination of outpatient follow-up and telephone calls.Results Among the 18 patients,12 underwent CT+MRI,4 underwent CT examination only,and 2 underwent MRI examination only.Among the 18 patients,14 had tumors located in the left lobe bile duct,2 in the right lobe bile duct,1 in the caudal lobe bile duct,and 1 at the junction of the left and right lobes of the liver.The tumor has a diameter of 2.8(2.7,2.9)cm and a range of 1.5-25.6 cm.All tumors are cystic and solid,with 11 cases presenting as multi cystic and 7 cases as single cyst-ic.The bile duct at the tumor site has"tumor like"expansion,and papillary,petal,and nodular lesions can be seen inside the expanded bile duct.Among them,13 cases of lesions are connected to the bile duct wall,and 5 cases have liquid gaps between the lesions and the bile duct wall.CT plain scan shows that the tumor is cystic and solid,with a uniformly low-density cystic portion;8 cases had uniform density of solid le-sions and 8 cases were uneven.There were 11 cases of papillary,petal,and nodular lesions with low density and 5 cases of equal density in the dilated bile duct.After CT enhancement,solid lesions,mild to moderate enhancement of the septum and capsule wall were observed in 3 cases during the arterial phase,with only 13 cases showing fine enhanced blood vessels.There were 4 cases of continuous mild enhancement of lesions in the portal phase,and no further enhancement was observed in 12 cases.The degree of reinforcement during the delay period decreases.MRI plain scan shows the tumor to be cystic and solid.The cystic portion on T,weighted imaging(T1WI)shows uniformly low signal,while T2 weighted imaging(T2WI)and diffusion-weighted imaging(DWI)show uniformly high signal.Solid lesions,septa,and cyst walls show equal or slightly low signal on T1WI,equal or high signal on T2WI,and papillary or strip-shaped high signal on DWI.After MRI enhancement,there were 4 cases of solid lesions,septal and cystic wall mild to moderate enhancement in the arterial phase,with only 10 cases showing fine enhanced blood vessels;5 cases showed continuous mild enhancement during the portal phase,and 9 cases did not show further enhancement;During the delay period,there were 4 cases of sustained mild enhancement and 10 cases of decreased enhancement.Conclusions IHBP is more common in the left lobe of the liver,and both CT and MRI show papillary,petal,and nodular lesions in the bile duct.The lesion site of the bile duct shows"tumor like"dilation.Solid lesion CT shows uniform or uneven low-density and isodensity,solid lesions on MRI T1WI show equal or low signal intensity,T2WI and DWI show equal or high signal intensity,after CT and MRI enhancement,both showed solid lesions,continuous uneven septal and cystic wall with mild to moderate enhancement.
关键词
胆管,肝内/乳头状瘤/体层摄影术,X线螺旋计算机/磁共振成像Key words
Bile ducts,intrahepatic/Papilloma/Tomography,X-ray spiral computed/Mag-netic resonance imaging引用本文复制引用
出版年
2024
NETL
NSTL
万方数据