本文選題：膽管細胞癌 + 磁共振成像�。� 參考：《福建醫(yī)科大學》2014年碩士論文

【摘要】：目的：分析腫塊型肝內膽管細胞癌(intrahepatic cholangiocarcinoma，ICC)的MRI表現，探討MRI平掃、動態(tài)增強及DWI對ICC的診斷和鑒別診斷的臨床價值。 資料和方法：分析50例我院經病理證實的肝臟膽管細胞癌患者的MRI影像學資料，所有患者術前均應用PhilipsAchieva1.5T MR或Siemens Verio3.0T掃描儀進行常規(guī)的MR平掃、動態(tài)增強及DWI檢查。觀察、分析MRI平掃征象及動態(tài)增強各期病灶的強化特點，對ICC影像特點如病灶形態(tài)、信號、增強的強化方式以及有無膽管擴張、肝包膜皺縮、肝葉萎縮，血管受侵程度、是否出現肝門區(qū)、腹膜后淋巴結轉移情況進行分析。測量病灶邊緣部分即早期強化處、病灶中央延遲強化區(qū)域以及同組患者正常肝組織ADC值，進行統(tǒng)計分析。 結果：(1)常規(guī)的MR平掃，，50例患者病灶均表現為不均勻或均勻的稍低T1、混雜T2信號，其中8例T2WI上病灶中心可見局灶性星芒狀或片狀低信號。（2）增強掃描，有25例病灶動脈期病灶邊緣呈厚或薄環(huán)狀、花環(huán)狀強化，門脈期、延遲期對比劑逐漸向病灶內填充，強化范圍增大，呈不均勻斑片狀強化，部分呈網格狀強化；19例病灶動脈期呈不均勻輕中度斑片狀強化，延遲期強化范圍增大，其中7例早期強化部分延遲期強化程度有所下降；4例病灶動脈期未見明顯強化者，靜脈期、延遲期病灶漸進性、向心性強化；有2例患者出現明顯較均勻強化，延遲掃描強化程度輕度減退，仍呈相對高信號，病灶中央可見小斑點狀低信號。（3）ICC的DWI呈不均勻稍高或高信號，腫瘤邊緣部分即早期強化處、病灶中央延遲強化區(qū)域以及同組患者正常肝組織的ADC值分別（1.05±0.24）×10－３mm２/s、（1.56±0.28）×10－３mm２/s、（1.29±0.15）×10－３mm２/s，組間兩兩比較差異有統(tǒng)計學意義（P＜0.05）。 結論：T2WI中心可見局灶性星芒狀或片狀低信號，增強掃描病灶周邊早期強化部分在延遲時可出現強化程度減低，腫塊周邊早期強化部分DWI呈高信號，ADC值下降，這些特征征象對ICC的MRI影像定性診斷和鑒別診斷具有重要的參考價值。
[Abstract]:Objective: to analyze the MRI features of intrahepatic cholangiocarcinoma (ICC) and to explore the clinical value of MRI plain scan, dynamic enhancement and DWI in the diagnosis and differential diagnosis of ICC. Materials and methods: the MRI imaging data of 50 patients with pathologically proved hepatic cholangiocarcinoma in our hospital were analyzed. PhilipsAchieva1.5T Mr or Siemens Verio3.0T scanner was used to perform conventional Mr plain scan, dynamic contrast enhancement and DWI before operation. To observe and analyze the features of MRI plain scan and dynamic enhancement of the lesions at different stages, and to analyze the features of ICC, such as shape, signal, enhancement mode of enhancement and whether there were dilatation of bile duct, shrinkage of hepatic capsule, atrophy of hepatic lobe, and degree of vascular invasion. The presence of hepatic hilar area and retroperitoneal lymph node metastasis were analyzed. The ADC values of early enhancement, central delayed enhancement and normal liver tissue in the same group were measured and analyzed statistically. Results the lesions of 50 patients with conventional Mr plain scan showed heterogeneity or homogeneity of slightly lower T _ 1 and mixed T _ 2 signal intensity. In 8 cases, focal starchy or flaky hypointensity was observed in the center of the lesion on T2WI. In 25 cases, the margin of the lesion appeared as thick or thin annular, flower-like enhancement, portal phase, delayed phase contrast agent gradually filled into the focus, the range of enhancement was enlarged, and the enhancement was uneven and patchy. Among the 19 patients with partial reticular enhancement, the arterial phase was uneven, mild to moderate plaque enhancement, and the range of delayed enhancement was increased. In 7 cases, the degree of partial delayed enhancement was decreased in 7 cases, and in 4 cases, no obvious enhancement was found in the arterial phase of the lesion. In the venous phase, the focus in the delayed phase was progressive and concentric enhancement, and there were 2 patients with obvious homogeneous enhancement and slight decrease in the enhancement degree of delayed scanning, which still showed relatively high signal intensity. In the center of the lesion, the DWI of small speckled hypointensity. The DWI of ICC was uneven or hyperintense, and the marginal part of the tumor was the early enhancement. The ADC values of the central delayed enhancement area and the normal liver tissue of the same group were 1.05 鹵0.24) 脳 10 -3 mm 2 / s (1.56 鹵0.28) 脳 10 -3 mm 2 / s and 1.29 鹵0.15 脳 10 -3 mm 2 / s respectively. There was significant difference between the two groups (P < 0.05). Conclusion the focal starlike or flaky hypointensity can be seen in the center of T2WI. The enhancement degree of the early enhancement part around the lesion may be decreased at the time of delay, and the DWI value of the early enhancement part around the mass is decreased with high signal intensity. These features have important reference value for MRI qualitative diagnosis and differential diagnosis of ICC.
【學位授予單位】：福建醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R445.2;R735.8

【參考文獻】

相關期刊論文 前9條

1 劉國保;羅久偉;成官迅;黎蕾;;肝內周圍型膽管細胞癌CT和MRI診斷及病理基礎研究[J];中國CT和MRI雜志;2012年01期

2 張東;;肝內膽管癌的病因學研究及預后分析[J];河北醫(yī)學;2013年10期

3 林國樂,趙玉沛,張家敏,張建希;肝膽管結石合并膽管癌(附16例臨床報告)[J];中華肝膽外科雜志;2000年03期

4 李紹林,張雪林,陳燕萍,陳斌,蒼鵬;肝內周圍型膽管細胞癌CT和MRI診斷及病理基礎研究[J];中華放射學雜志;2004年10期

5 ;Risk factors for intrahepatic cholangiocarcinoma:A case-control study in China[J];World Journal of Gastroenterology;2008年04期

6 吳健雄;胡士杰;榮維淇;王黎明;邵永孚;;41例肝內膽管細胞癌的診斷和治療分析[J];中國醫(yī)學科學院學報;2006年03期

7 陳立達;徐輝雄;;肝內膽管細胞癌的影像學診斷進展[J];中國醫(yī)學影像技術;2007年03期

8 孫燦輝;李子平;徐輝雄;孟悛非;馮仕庭;范淼;彭振鵬;郭歡儀;;周圍型肝內膽管細胞癌的CT和超聲雙期增強的比較研究[J];中國醫(yī)學影像技術;2008年01期

9 張海萍;;CT和MRI在膽管細胞癌中的診斷價值對比分析[J];北華大學學報(自然科學版);2013年04期

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