肝细胞癌合并胆管癌栓的CT表现及临床应用价值

doi:10.3877/cma.j.issn.1674-0793.2019.03.013

中华普通外科学文献(电子版) ›› 2019, Vol. 13 ›› Issue (03) : 228 -232. doi: 10.3877/cma.j.issn.1674-0793.2019.03.013

所属专题：文献；

论著

肝细胞癌合并胆管癌栓的CT表现及临床应用价值

梁伟强¹, 蔡华崧², 周小琦², 王猛²^,^†(

)

^1. 529100　江门，新会中医院放射科
^2. 510080　广州，中山大学附属第一医院放射诊断专科

收稿日期:2018-12-12 出版日期:2019-06-01
通信作者: 王猛
基金资助:
国家重点研发计划项目(2017YFC0113402)

CT findings and clinical application of hepatocellular carcinoma with bile duct tumor thrombus

Weiqiang Liang¹, Huasong Cai², Xiaoqi Zhou², Meng Wang²^,^†()

^1. Department of Diagnostic Radiology, XinhuiTraditional Chinese Medicine Hospital, Jiangmen 529100, China
^2. Department of Diagnostic Radiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China

Received:2018-12-12 Published:2019-06-01
Corresponding author: Meng Wang
About author:
Corresponding author: Wang Meng, Email: king_6509@sina.com

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目的

分析肝细胞癌（HCC）合并胆管癌栓的CT表现，以期提高对HCC合并胆管癌栓的影像诊断水平。

方法

收集2012年1月至2018年9月中山大学附属第一医院和江门市新会中医院26例HCC合并胆管癌栓患者资料，病例均经手术后病理证实，并行64排螺旋CT平扫及双期（动脉期和门静脉期）增强扫描。回顾性分析其CT表现，包括受累胆管的位置、胆管内癌栓的密度、强化方式、肝内肿块与胆管癌栓的关系、胆管壁的情况。以手术及病理结果为"金标准"，分析CT对HCC合并胆管癌栓定位及定性的准确性。

结果

26例均明确诊断为肝内肿块及胆管内肿块，HCC和胆管癌栓在CT上均清楚显示。原发HCC的CT增强扫描表现为三种强化方式："快进快退"18例（69.2%），"快进慢退"4例（15.4%），"三低"4例（15.4%）；胆管癌栓CT表现为扩张的胆管内填充有软组织块影，胆管远端扩张，胆管壁无增厚。24例（92.3%）HCC与癌栓相连，2例（7.7%）HCC与胆管癌栓不相连。增强扫描25例（96.2%）癌栓强化方式与肝内肿瘤的强化方式一致，1例（3.8%）强化方式不一致。CT对HCC合并胆管癌栓的检出例数、成像位置与手术及病理结果基本一致，准确性为100.0%（26/26）。

结论

HCC合并胆管癌栓的CT表现具有一定的特征性，仔细分析肝内肿块及胆管内癌栓的CT表现，有助于疾病诊断。

关键词: 癌，肝细胞, 肿瘤细胞，循环, 体层摄影术，螺旋计算机, 胆管癌栓

Objective

To analyze the CT findings of hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT).

Methods

From January 2012 to September 2018, twenty-six cases of HCC with BDTT were collected from the First Affiliated Hospital of Sun Yat-sen University and Xinhui Traditional Chinese Medicine Hospital. All cases were confirmed by pathology after operation, 64-slice spiral CT plain scan and dual-phase enhanced scan (arterial phase and portal phase) were performed. The imaging features, including distribution, density and enhancement patterns of HCC and BDTT, relationship of HCC with BDTT and situation of the bile duct wall, were retrospectively analyzed. Based on the results of operation and pathology as "golden standard", the accuracy of CT in localization and qualitative analysis of HCC with BDTT was analyzed.

Results

All the 26 cases were diagnosed as intrahepatic and intraductal masses, HCC and BDTT clearly displayed on CT. On contrast-enhanced CT images, HCC with BDTT showed three types of enhancement pattern: fast in and fast out (18 cases, 69.2%), fast in and slow out (4 cases, 15.4%), and all low density (4 cases, 15.4%). BDTT showed dilated bile ducts filled and soft tissue masses, with distal bile duct dilation, without bile duct wall thickening. HCC was directly associated with BDTT in 24 cases (92.3%), but not associated in 2 cases (7.7%). The enhancement type of BDTT was similar with HCC lesion in 25 cases (96.2%), but different in 1 case (3.8%). The accuracy of CT in detecting HCC with BDTT was 100.0% (26/26).

Conclusion

The CT imaging of HCC with BDTT has certain characteristics, which is helpful for the diagnosis of the disease.

Key words: Carcinoma, hepatocellular, Neoplastic cells, circulating, Tomography, spiral computed, Bile duct tumor thrombus

图1 原发肿瘤的CT平扫及增强扫描表现　箭头所示为CT平扫示肝S2见1个等/稍低密度病灶（A），密度稍欠均匀，边界不清；增强扫描动脉期示肝细胞癌强化程度高于周围正常肝实质（B）；静脉期肝细胞癌强化程度低于周围正常肝实质（C）

图2 胆管癌栓的CT表现　与图1为同一例患者，箭头所示为CT平扫胆总管见一软组织密度影，密度较均匀（A）；增强扫描动脉期示癌栓强化程度高于周围正常肝实质（B）；静脉期示癌栓强化程度低于周围正常肝实质（C）

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