肿块型肝内胆管癌Gd-EOB-DTPA增强MRI影像表现的研究-东南大学学报医学版

肿块型肝内胆管癌Gd-EOB-DTPA增强MRI影像表现的研究

单位：1. 南京大学医学院附属鼓楼医院医学影像科, 江苏南京 210008;
2. 江苏省中医院放射科, 江苏南京 210008;
3. 南京大学医学院附属鼓楼医院病理科, 江苏南京 210008

分类号：R735.7;R730.4

出版年·卷·期（页码）：2020·39·第三期（335-341）

摘要：

目的:总结肿块型肝内胆管癌(IMCC)钆塞酸二钠(Gd-EOB-DTPA)增强MRI的影像特征,探索动态强化模式与病灶最大径的相关性。方法:回顾性分析经病理证实的73例IMCC基本MRI征象、增强多期强化特点以及动态强化模式。将IMCC依据肿瘤最大径分组,并比较病灶最大径 ≤ 5 cm与>5 cm的IMCC的影像表现差异。结果:IMCC主要表现为T1WI低信号和T2WI高信号,47例表现DWI靶征,38例可见肝胆期靶征。IMCC的Gd-EOB-DTPA 增强MRI强化模式以渐进强化型为主(61.6%),其次是持续强化型(20.6%),增强减退型(9.6%)、向心强化型(5.5%)及无强化型(2.7%)比例较低。最大径 ≤ 5 cm与>5 cm的IMCC在强化模式上差异无统计学意义(P=0.588)。结论:DWI靶征及肝胆期靶征有助于IMCC诊断。IMCC的Gd-EOB-DTPA增强MRI动态强化模式以渐进强化型为主,强化模式与病灶最大径无显著相关性。

Objective:To summarize the imaging features of Gd-EOB-DTPA enhanced MRI for intrahepatic mass-forming cholangiocarcinoma (IMCC), and to evaluate the relationship of dynamic enhancement modes with tumor size. Methods:73 cases of pathologically confirmed IMCC were retrospectively analyzed for basic MRI signs, enhancement characteristics of dynamic multiphase and dynamic enhancement mode. The IMCCs were grouped according to tumor size, and the MRI features of IMCCs with a maximum lesion diameter of ≤ 5 cm and>5 cm were compared. Results:IMCC mainly showed high SI on T2-weighted images and low SI on T1-weighted images, 47 cases showed target-sign on diffusion weighted imaging (DWI) and 38 cases showed target-sign on hepatobiliary phase. The Gd-EOB-DTPA enhanced MRI enhancement patterns of IMCC were mainly progressive type (61.6%), followed by continuous type (20.6%), decreased type (9.6%), concentric type (5.5%) and and no enhancement (2.7%). IMCCs with a maximum diameter of ≤ 5 cm and>5 cm had no significant difference in the dynamic enhancement modes (P=0.588). Conclusion:Target signs on DWI and HBP are helpful for IMCC diagnosis. The dynamic enhancement mode is mainly progressive enhancement pattern, which has no significant correlation with the tumor size.

参考文献：

[1] JIANG B G, SUN L L, YU W L, et al.Retrospective analysis of histopathologic prognostic factors after hepatectomy for intrahepatic cholangiocarcinoma[J].Cancer J, 2009,15(3):257-261.
[2] KANG Y, LEE J M, KIM S H, et al.Intrahepatic mass-forming cholangiocarcinoma: enhancement patterns on gadoxetic acid-enhanced MR images [J].Radiology, 2012,264(3):751-760.
[3] CIRESA M, DE GAETANO A M, POMPILI M, et al.Enhancement patterns of intrahepatic mass-forming cholangiocarcinoma at multiphasic computed tomography and magnetic resonance imaging and correlation with clinicopathologic features [J].Eur Rev Med Pharmacol Sci, 2015, 19(15):2786-2797.
[4] 李绍林,张雪林,陈燕萍,等. 肝内周围型胆管细胞癌CT和MRI诊断及病理基础研究[J].中华放射学杂志,2004,38(10):1072-1074.
[5] CHEN L D, XU H X, XIE X Y, et al.Enhancement patterns of intrahepatic cholangiocarcinoma: comparison between contrast-enhanced ultrasound and contrast-enhanced CT[J].Br J Radiol, 2008,81(971):881-889.
[6] RIMOLA J, FORNER A, REIG M, et al.Cholangiocarcinoma in cirrhosis: absence of contrast washout in delayed phases by magnetic resonance imaging avoids misdiagnosis of hepatocellular carcinoma [J].Hepatology, 2009,50(3):791-798.
[7] 张少平,郑锦阳,陈向荣,等. 高分化肝细胞癌的MRI表现[J].中国现代医学杂志,2015, 25(18):21-25.
[8] AHN S S, KIM M J, LIM J S, et al.Added value of gadoxetic acid-enhanced hepatobiliary phase MR imaging in the diagnosis of hepatocellular carcinoma[J].Radiology, 2010, 255(2):459-466.
[9] KIM S H, LEE C H, KIM B H, et al.Typical and atypical imaging findings of intrahepatic cholangiocarcinoma using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging[J].J Comput Assist Tomogr, 2012, 36(6):704-709.
[10] VALLS C, GUMA A, PUIG I, et al.Intrahepatic peripheral cholangiocarcinoma: CT evaluation [J].Abdom Imaging, 2000, 25(5):490-496.
[11] HARADOME H, UNNO T, MORISAKA H, et al.Gadoxetic acid disodium-enhanced MR imaging of cholangiolocellular carcinoma of the liver: imaging characteristics and histopathological correlations[J].Eur Radiol, 2017,27(11):4461-4471.
[12] GRANATA V, CATALANO O, FUSCO R, et al.The target sign in colorectal liver metastases: an atypical Gd-EOB-DTPA "uptake" on the hepatobiliary phase of MR imaging[J].Abdom Imaging, 2015,40(7):2364-2371.
[13] HA S, LEE C H, KIM B H, et al.Paradoxical uptake of Gd-EOB-DTPA on the hepatobiliary phase in the evaluation of hepatic metastasis from breast cancer: is the "target sign" a common finding?[J].Magn Reson Imaging, 2012,30(8):1083-1090.
[14] PARK M J, KIM Y K, PARK H J, et al.Scirrhous hepatocellular carcinoma on gadoxetic acid-enhanced magnetic resonance imaging and diffusion-weighted imaging: emphasis on the differentiation of intrahepatic cholangiocarcinoma [J].J Comput Assist Tomogr, 2013, 37(6):872-881.
[15] HAN J K, CHOI B I, KIM A Y, et al.Cholangiocarcinoma: pictorial essay of CT and cholangiographic findings [J].Radiographics, 2002, 22(1):173-187.
[16] MOTOSUGI U, ICHIKAWA T, NAKAJIMA H, et al.Cholangiolocellular carcinoma of the liver: imaging findings [J].J Comput Assist Tomogr, 2009, 33(5):682-688.
[17] FUKUKURA Y, HAMANOUE M, FUJIYOSHI F, et al.Cholangiolocellular carcinoma of the liver: CT and MR findings [J].J Comput Assist Tomogr, 2000, 24(5):809-812.
[18] NICOLAU C, VILANA R, CATALA V, et al.Importance of evaluating all vascular phases on contrast-enhanced sonography in the differentiation of benign from malignant focal liver lesions[J].AJR Am J Roentgenol, 2006, 186(1):158-167.
[19] NANASHIMA A, SUMIDA Y, ABO T, et al.Relationship between pattern of tumor enhancement and clinicopathologic characteristics in intrahepatic cholangiocarcinoma[J].J Surg Oncol, 2008,98 (7):535-539.

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