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1、周围型肝内胆管细胞癌的MRI诊断福建省立医院磁共振(350001)包强王尔祯林梅林孟光严刚【摘要】目的：分析周围型肝内胆管细胞癌(PCC)的MRI表现及其误漏诊原因。材料与方法：木文收集12例经手术、病理证实的PCC。术而MRI谋漏诊3例。MRI检查技术：常规行T1WI和或准T1WLT2WI和或脂肪抑制T2WI；加行动态增强扫描10例，磁共振胰胆管造影(MRCP)10例。常规行横断面扫描，辅以冠状及矢状面扫描。结合手术及病理所见分析MRI表现。结果：周围型肝内胆管细胞癌MRI主要表现为不规则浸润性占位，T1WI均呈混杂低信号，实质部分呈略低信号，坏死、囊变区呈低信号，间朵扩张的小胆管或粘液湖呈
2、更低信号。T2WI：均呈混杂的高信号，实质部呈略高信号，坏死、囊变区及扩张小胆管与粘液湖呈明显高信号。多可见病灶内或周围扩张小胆管。动态增强扫描：动脉期病灶强化不明显或病灶边缘及部分实质轻度强化，门静脉期及延时扫描病灶呈进行性、向心性强化。MRCP可见病灶区胆管走向杂乱、僵直、各种形态截断狭窄及病灶周围小胆管扩张。MRI漏诊原因：例1为多次胆道结石术后残余结右并发PCC,且部分PCC坏死囊变区感染形成肝脓肿。例2为多次胆道结石术后再发肝内外胆管结石，并发肝硬化、PCC,且PCC多发坏死囊变。例3为肝内外胆管、皿囊多发结石并炎症，右肝明显萎缩并发PCCo结论：PCC的MRI表现具冇一定的特点，诊
3、断准确率较高，但必须平扫、动态增强、MRCP相结合分析，排除合并胆道结石与肝脓肿的影像干扰，方可减少谋漏诊。【关键词】胆管细胞癌；磁共振成像；手术；病理MRIDiagnosisofPeripheralCholangiocarcinomaBaoQiang,WangErzhen,LinMei,LinMenguan,YanGan.DepartmentofRadiology,FujianProvincialHosptial,Fuzhou350001,China[Abstract]ObjectiveToanalyseMRIfindingsofperipheralcholangiocarcinoma(PC
4、C)andthecausesofmisdiagnosisandmisseddiagnosis.MaterialsandMethodsTwelvecasesofPCCconfirmedsurgicallyandpathologicallywerecollected・ExaminationtechniquesT1WIand(or)T1*WI,T2WIand(or)fat-suppressedT2WIwereroutinelyperformed;Dynamicenhancementswereaddedin10casesandMRCP10cases・MRIfindingsalongwithoperat
5、ionalandpathologicalfindingswereanalysed・ResultsPCCweremainlyshownasirregularinfiltrativemasses.OnT1IWthemasseswereallwithmixedhypointensity,thesolidpartsofthemasseswerewithslightlylowsignals,thenecroticandcysticpartswerewithlowsignals,themixedanddilatedsmallbileductsormucouslakeswerewithevenlowersi
6、gnals.OnT2WIallthemasseswereshownasmixedhyperintensity,thesolidpartsofwhichwerewithslightlyhighsignals,thenecroticandcysticpart,dilatedsmallbileductsandmucouslakeswereallwithhighersignals.Thedilatedsmallbileductsinsideoraroundthelesionswerefrequentlyseen.DynamicEnhancement:Ataterialphasethelesionssh
7、owednoobviousenhancement,orslightenhancementsattheedgeorsolidpartsofthelesions;atportalvenousphaseanddelayedphaseprogressiveandconcentricenhancementwereshown.WithMRCPdisoriented,rigidbileductswereshow
