肝内胆管细胞癌影像诊断及鉴别诊断课件.pptVIP

CT 表现 ? 肿块型：平扫表现为分叶状、不规则低密度肿物 ，无包膜。肿块内或周围可见扩张胆管形成的条 索状更低密度影。增强扫描早期肿瘤周边轻度、 不完全环形强化，密度高于同层肝组织。中央部 分不增强或轻度网格状、结节状强化，低于同层 正常肝组织。延迟增强为最特征的表现，即在注 射造影剂后 3-9min 或更长时间，肿瘤才开始强化 ，强化程度高于同层肝组织，造影剂进入及流出 均较慢，表现为“慢进慢出”的特点。其他伴随 征象有肝叶萎缩，可能与胆管阻塞或门脉受侵致 血供不足有关。 11 ? Mass-forming cholangiocarcinoma. (a) Contrast material – enhanced computed tomographic (CT) scan shows bile duct dilatation with a poorly enhancing lesion in the adjacent liver (arrows). There is significant parenchymal atrophy with capsular retraction peripheral to the more centrally located cholangiocarcinoma. ? (b) Photograph of the gross specimen clearly depicts a large mass (arrowheads) around the sclerotic bile duct. 12 管周浸润型 ? 常仅见局部胆管壁不规则增厚，官腔狭窄， 界限不清，远端胆管扩张。增强扫描呈树枝 状或长条状强化。偶见点片状高密度结石影 。肝包膜可回缩内凹，因肿瘤内纤维间质较 丰富，浸润生长牵拉局部肝包膜所致。 13 14 Periductal infiltrating cholangiocarcinoma. (a) Axial T2-weighted MR image shows a dilated peripheral intrahepatic duct with a slightly hyperintense lesion around the duct (arrow).(b) Contrast-enhanced equilibrium phase MR image shows periductal enhancement around the dilated intrahepatic duct (arrowheads). (c) Photograph of the gross specimen reveals a periductal infiltrating tumor (arrows) along the irregularly dilated intrahepatic duct . 15 管内生长型 ? 可见胆管内乳头状、分叶状肿物，增强扫描 有强化，比肝实质稍低，但无延迟期强化。 有时胆管显著扩张呈囊状，表现为无强化， 边界清晰的更低密度区。 16 Intraductal cholangiocarcinoma. (a) CT scan shows a soft-tissue component filling a mildly dilated duct (arrow). (b) MR cholangiopancreatogram shows the mildly dilated duct with irregularities that mimic impacted stones (arrowheads). (c) Photograph of the gross specimen reveals a dilated bile duct with innumerable impacted small polypoid lesions representing tubular carcinomas without mucin production. 17 MRI 表现 ? 各型特征与 CT 表现类似，肿瘤在 T1WI 上呈低 信号， T2WI 为不均匀高信号。 18 影像学与病理对照 ? 肝内胆管细胞癌的影像学表现由病理类型与 组织学成分所决定。组织学上肿块主要由恶 性肿瘤细胞、纤维组织、凝固性坏死和粘蛋 白构成，在不同的组织类型和肿瘤的不同区 域各种成分所占的比例和分布特点明显不同 。 19 肿块型 ICC 强化方式 ? 一、动脉期肿块周边轻度强化