Ⅲ型肝细胞与胆管细胞混合性肝癌的MRI表现
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摘要
目的:探讨Ⅲ型肝细胞与胆管细胞混合性肝癌(cHCC-CC)的MRI表现。方法:回顾性分析15例经病理证实的Ⅲ型cHCC-CC患者的临床及MRI资料,其中12例行MRI平扫+增强扫描,3例行MRI平扫。结果:15例Ⅲ型cHCC-CC均为单发实性肿物,边界清楚13例,形态规则10例,T1WI呈高信号4例,T2WI呈中高信号15例。12例行动态增强扫描,其中强化方式为流出型3例,动脉早期肿瘤边缘强化6例,延迟期边缘包膜样强化9例,延迟期中心持续强化4例。伴随表现包括伴肝硬化(8例)、肝被膜凹陷(4例)、肝内胆管扩张(2例)、淋巴结转移(6例)等。应用同时出现肝细胞肝癌(HCC)和肝内胆管细胞癌(ICC)表现作为诊断Ⅲ型cHCC-CC的标准,MRI平扫、增强扫描的诊断敏感度分别为46.7%(7/15)和58.3%(7/12),差异无统计学意义(P>0.05)。单独应用非流出型强化方式和延迟期包膜样强化这两种征象进行诊断,敏感度为58.3%(7/12)。结论:应用同时出现HCC和ICC表现作为诊断Ⅲ型cHCC-CC的标准,或应用强化方式为非流出型及延迟期有边缘包膜样强化这两种征象作为诊断标准,均可得到较好的诊断敏感度。
Objective:To investigate MRI features of typeⅢcombined hepatocellular carcinoma and cholangiocarcinoma(cHCC-CC).Methods:MRI images of 15 typeⅢ cHCC-CCs were retrospectively analyzed.12 underwent unenhanced and dynamic contrast enhanced MRI,and 3 underwent unenhanced MRI.Results:All casess were solitary,13 had well-demarcated margin,10 had regular contour,4 showed hyperintensity on T1 WI and 15 showed hyperintensity on T2 WI.In 12 contrast-enhanced cases,3 showed wash-out type,6 showed rim-like enhancement in early arterial phase,9 had capsular enhancement and 4 showed central enhancement in the delayed phase.Accompanied signs included cirrhosis(n=8),liver capsular retraction(n=4),intrahepatic bile duct dilatation(n=2),and lymphadenopathy(n=6).Using HCC-like and ICC-like appearance as diagnostic reference,the sensitivity of unenhanced MRI and dynamic contrats enhanced MRI were 46.7%(7/15)and 58.3%(7/12),respectively,without significant difference(P>0.05).Using non-wash out type and capsular enhancement in delayed phase as reference,the sensitivity was 58.3%(7/12).Conclusion:Using both HCC-like and ICC-like manifestations,or non-wash out type and capsular enhancement in delayed phase,MRI can be valuable for diagnosis of typeⅢcHCC-CC.
Objective:To investigate MRI features of typeⅢcombined hepatocellular carcinoma and cholangiocarcinoma(cHCC-CC).Methods:MRI images of 15 typeⅢ cHCC-CCs were retrospectively analyzed.12 underwent unenhanced and dynamic contrast enhanced MRI,and 3 underwent unenhanced MRI.Results:All casess were solitary,13 had well-demarcated margin,10 had regular contour,4 showed hyperintensity on T1 WI and 15 showed hyperintensity on T2 WI.In 12 contrast-enhanced cases,3 showed wash-out type,6 showed rim-like enhancement in early arterial phase,9 had capsular enhancement and 4 showed central enhancement in the delayed phase.Accompanied signs included cirrhosis(n=8),liver capsular retraction(n=4),intrahepatic bile duct dilatation(n=2),and lymphadenopathy(n=6).Using HCC-like and ICC-like appearance as diagnostic reference,the sensitivity of unenhanced MRI and dynamic contrats enhanced MRI were 46.7%(7/15)and 58.3%(7/12),respectively,without significant difference(P>0.05).Using non-wash out type and capsular enhancement in delayed phase as reference,the sensitivity was 58.3%(7/12).Conclusion:Using both HCC-like and ICC-like manifestations,or non-wash out type and capsular enhancement in delayed phase,MRI can be valuable for diagnosis of typeⅢcHCC-CC.
引文
[1]Aaltonen LA,Hamilton SR,World Health Organization,et al.Pathology and genetics of tumours of the digestive system[M].Lyon:Oxford University Press,2000:314-314.
[2]Allen RA,Lisa JR.Combined liver cell and bile duct carcinoma[J].Am J Pathol,1949,25(4):647-655.
[3]Lee CH,Hsieh SY,Chang CJ,et al.Comparison of clinical characteristics of combined hepatocellular-cholangiocarcinoma and other primary liver cancers[J].J Gastroenterol Hepatol,2013,28(1):122-127.
[4]Lee JH,Chung GE,Yu SJ,et al.Long-term prognosis of combined hepatocellular and cholangiocarcinoma after curative resection comparison with hepatocellular carcinoma and cholangiocarcinoma[J].J Clin Gastroenterol,2011,45(1):69-75.
[5]Kim KH,Lee SG,Park EH,et al.Surgical treatments and prognoses of patients with combined hepatocellular carcinoma and cholangiocarcinoma[J].Ann Surg Oncol,2009,16(3):623-629.
[6]Zhan Q,Shen BY,Deng XX,et al.Clinical and pathological analysis of 27patients with combined hepatocellular-cholangiocarcinoma in an Asian center[J].J Hepatobiliary Pancreat Sci,2012,19(4):361-369.
[7]Panjala C,Senecal DL,Bridges MD,et al.The diagnostic conundrum and liver transplantation outcome for combined hepatocellular-cholangiocarcinoma[J].Am J Transplant,2010,10(5):1263-1267.
[8]Kassahun WT,Hauss J.Management of combined hepatocellular and cholangiocarcinoma[J].Int J Clin Pract,2008,62(8):1271-1278.
[9]Yin X,Zhang BH,Qiu SJ,et al.Combined hepatocellular carcinoma and cholangiocarcinoma:clinical features,treatment modalities,and prognosis[J].Ann Surg Oncol,2012,19(9):2869-2876.
[10]Park H,Choi KH,Choi SB,et al.Clinicopathological characteristics in combined hepatocellular-cholangiocarcinoma:a single center study in Korea[J].Yonsei Med J,2011,52(5):753-760.
[11]Aoki K,Takayasu K,Kawano T,et al.Combined hepatocellular carcinoma and cholangiocarcinoma:clinical features and computed tomographic findings[J].Hepatology,1993,18(5):1090-1095.
[12]Fukukura Y,Taguchi J,Nakashima O,et al.Combined hepatocellular and cholangiocarcinoma:correlation between CT findings and clinicopathological features[J].J Comput Assist Tomogr,1997,21(1):52-58.
[13]de Campos RO,Semelka RC,Azevedo RM,et al.Combined hepatocellular carcinoma-cholangiocarcinoma:report of MR appearance in eleven patients[J].J Magn Reson Imaging,2012,36(5):1139-1147.
[14]Ebied O,Federle MP,Blachar A,et al.Hepatocellular-cholangiocarcinoma:helical computed tomography findings in 30patients[J].J Comput Assist Tomogr,2003,27(2):117-124.
[15]Hwang J,Kim YK,Park MJ,et al.Differentiating combined hepatocellular and cholangiocarcinoma from mass-forming intrahepatic cholangiocarcinoma using gadoxetic acid-enhanced MRI[J].J Magn Reson Imaging,2012,36(4):881-889.
[16]Kim YK,Han YM,Kim CS.Comparison of diffuse hepatocellular carcinoma and intrahepatic cholangiocarcinoma using sequentially acquired gadolinium-enhanced and Resovist-enhanced MRI[J].Eur J Radiol,2009,70(1):94-100.
[17]Karahan OI,Yikilmaz A,Artis T,et al.Contrast-enhanced dynamic magnetic resonance imaging findings of hepatocellular carcinoma and their correlation with histopathologic findings[J].Eur J Radiol,2006,57(3):445-452.
[18]Ito K.Hepatocellular carcinoma:conventional MRI findings including gadolinium-enhanced dynamic imaging[J].Eur J Radiol,2006,58(2):186-199.
[19]Iannaccone R,Piacentini F,Murakami T,et al.Hepatocellular carcinoma in patients with nonalcoholic fatty liver disease:helical CT and MR imaging findings with clinical-pathologic comparison[J].Radiology,2007,243(2):422-430.
[20]Kang Y,Lee JM,Kim SH,et al.Intrahepatic mass-forming cholangiocarcinoma:enhancement patterns on gadoxetic acid-enhanced MR images[J].Radiology,2012,264(3):751-760.
[21]Portolani N,Baiocchi GL,Coniglio A,et al.Intrahepatic cholangiocarcinoma and combined hepatocellular-cholangiocarcinoma:a Western experience[J].Ann Surg Oncol,2008,15(7):1880-1890.
[22]Wells HG.Primary carcinoma of the liver[J].Amer J Med Sci,1903,126(3):403-417.
[23]Lee WS,Lee KW,Heo JS,et al.Comparison of combined hepatocellular and cholangiocarcinoma with hepatocellular carcinoma and intrahepatic cholangiocarcinoma[J].Surg Today,2006,36(10):892-897.
[24]Kim JH,Yoon HK,Ko GY,et al.Nonresectable combined hepatocellular carcinoma and cholangiocarcinoma:analysis of the response and prognostic factors after transcatheter arterial chemoembolization[J].Radiology,2010,255(1):270-277.
[25]Ng IO,Shek TW,Nicholls J,et al.Combined hepatocellularcholangiocarcinoma:a clinicopathological study[J].J Gastroenterol Hepatol,1998,13(1):34-40.
[26]Hurlimann J,Gardiol D.Immunohistochemistry in the differential diagnosis of liver carcinomas[J].Am J Surg Pathol,1991,15(3):280-288.
[27]Hashimoto T,Nakamura H,Hori S,et al.MR imaging of mixed hepatocellular and cholangiocellular carcinoma[J].Abdom Imaging,1994,19(5):430-432.
[28]Jarnagin WR,Weber S,Tickoo SK,et al.Combined hepatocellular and cholangiocarcinoma:demographic,clinical,and prognostic factors[J].Cancer,2002,94(7):2040-2046.
[29]Sagrini E,Lavarone M,Stefanini F,et al.Imaging of combined hepatocellular-cholangiocarcinoma in cirrhosis and risk of false diagnosis of hepatocellular carcinoma[J].United European Gastroenterol J,2019,7(1):69-77.
[30]Sasaki M,Sato Y,Nakanuma Y.Mutational landscape of combined hepatocellular carcinoma and cholangiocarcinoma,and its clinicopathological significance[J].Histopathology,2017,70(3):423-434.
[2]Allen RA,Lisa JR.Combined liver cell and bile duct carcinoma[J].Am J Pathol,1949,25(4):647-655.
[3]Lee CH,Hsieh SY,Chang CJ,et al.Comparison of clinical characteristics of combined hepatocellular-cholangiocarcinoma and other primary liver cancers[J].J Gastroenterol Hepatol,2013,28(1):122-127.
[4]Lee JH,Chung GE,Yu SJ,et al.Long-term prognosis of combined hepatocellular and cholangiocarcinoma after curative resection comparison with hepatocellular carcinoma and cholangiocarcinoma[J].J Clin Gastroenterol,2011,45(1):69-75.
[5]Kim KH,Lee SG,Park EH,et al.Surgical treatments and prognoses of patients with combined hepatocellular carcinoma and cholangiocarcinoma[J].Ann Surg Oncol,2009,16(3):623-629.
[6]Zhan Q,Shen BY,Deng XX,et al.Clinical and pathological analysis of 27patients with combined hepatocellular-cholangiocarcinoma in an Asian center[J].J Hepatobiliary Pancreat Sci,2012,19(4):361-369.
[7]Panjala C,Senecal DL,Bridges MD,et al.The diagnostic conundrum and liver transplantation outcome for combined hepatocellular-cholangiocarcinoma[J].Am J Transplant,2010,10(5):1263-1267.
[8]Kassahun WT,Hauss J.Management of combined hepatocellular and cholangiocarcinoma[J].Int J Clin Pract,2008,62(8):1271-1278.
[9]Yin X,Zhang BH,Qiu SJ,et al.Combined hepatocellular carcinoma and cholangiocarcinoma:clinical features,treatment modalities,and prognosis[J].Ann Surg Oncol,2012,19(9):2869-2876.
[10]Park H,Choi KH,Choi SB,et al.Clinicopathological characteristics in combined hepatocellular-cholangiocarcinoma:a single center study in Korea[J].Yonsei Med J,2011,52(5):753-760.
[11]Aoki K,Takayasu K,Kawano T,et al.Combined hepatocellular carcinoma and cholangiocarcinoma:clinical features and computed tomographic findings[J].Hepatology,1993,18(5):1090-1095.
[12]Fukukura Y,Taguchi J,Nakashima O,et al.Combined hepatocellular and cholangiocarcinoma:correlation between CT findings and clinicopathological features[J].J Comput Assist Tomogr,1997,21(1):52-58.
[13]de Campos RO,Semelka RC,Azevedo RM,et al.Combined hepatocellular carcinoma-cholangiocarcinoma:report of MR appearance in eleven patients[J].J Magn Reson Imaging,2012,36(5):1139-1147.
[14]Ebied O,Federle MP,Blachar A,et al.Hepatocellular-cholangiocarcinoma:helical computed tomography findings in 30patients[J].J Comput Assist Tomogr,2003,27(2):117-124.
[15]Hwang J,Kim YK,Park MJ,et al.Differentiating combined hepatocellular and cholangiocarcinoma from mass-forming intrahepatic cholangiocarcinoma using gadoxetic acid-enhanced MRI[J].J Magn Reson Imaging,2012,36(4):881-889.
[16]Kim YK,Han YM,Kim CS.Comparison of diffuse hepatocellular carcinoma and intrahepatic cholangiocarcinoma using sequentially acquired gadolinium-enhanced and Resovist-enhanced MRI[J].Eur J Radiol,2009,70(1):94-100.
[17]Karahan OI,Yikilmaz A,Artis T,et al.Contrast-enhanced dynamic magnetic resonance imaging findings of hepatocellular carcinoma and their correlation with histopathologic findings[J].Eur J Radiol,2006,57(3):445-452.
[18]Ito K.Hepatocellular carcinoma:conventional MRI findings including gadolinium-enhanced dynamic imaging[J].Eur J Radiol,2006,58(2):186-199.
[19]Iannaccone R,Piacentini F,Murakami T,et al.Hepatocellular carcinoma in patients with nonalcoholic fatty liver disease:helical CT and MR imaging findings with clinical-pathologic comparison[J].Radiology,2007,243(2):422-430.
[20]Kang Y,Lee JM,Kim SH,et al.Intrahepatic mass-forming cholangiocarcinoma:enhancement patterns on gadoxetic acid-enhanced MR images[J].Radiology,2012,264(3):751-760.
[21]Portolani N,Baiocchi GL,Coniglio A,et al.Intrahepatic cholangiocarcinoma and combined hepatocellular-cholangiocarcinoma:a Western experience[J].Ann Surg Oncol,2008,15(7):1880-1890.
[22]Wells HG.Primary carcinoma of the liver[J].Amer J Med Sci,1903,126(3):403-417.
[23]Lee WS,Lee KW,Heo JS,et al.Comparison of combined hepatocellular and cholangiocarcinoma with hepatocellular carcinoma and intrahepatic cholangiocarcinoma[J].Surg Today,2006,36(10):892-897.
[24]Kim JH,Yoon HK,Ko GY,et al.Nonresectable combined hepatocellular carcinoma and cholangiocarcinoma:analysis of the response and prognostic factors after transcatheter arterial chemoembolization[J].Radiology,2010,255(1):270-277.
[25]Ng IO,Shek TW,Nicholls J,et al.Combined hepatocellularcholangiocarcinoma:a clinicopathological study[J].J Gastroenterol Hepatol,1998,13(1):34-40.
[26]Hurlimann J,Gardiol D.Immunohistochemistry in the differential diagnosis of liver carcinomas[J].Am J Surg Pathol,1991,15(3):280-288.
[27]Hashimoto T,Nakamura H,Hori S,et al.MR imaging of mixed hepatocellular and cholangiocellular carcinoma[J].Abdom Imaging,1994,19(5):430-432.
[28]Jarnagin WR,Weber S,Tickoo SK,et al.Combined hepatocellular and cholangiocarcinoma:demographic,clinical,and prognostic factors[J].Cancer,2002,94(7):2040-2046.
[29]Sagrini E,Lavarone M,Stefanini F,et al.Imaging of combined hepatocellular-cholangiocarcinoma in cirrhosis and risk of false diagnosis of hepatocellular carcinoma[J].United European Gastroenterol J,2019,7(1):69-77.
[30]Sasaki M,Sato Y,Nakanuma Y.Mutational landscape of combined hepatocellular carcinoma and cholangiocarcinoma,and its clinicopathological significance[J].Histopathology,2017,70(3):423-434.