肝门区常见肿瘤的MRI诊断及对术前评估价值的研究
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摘要
[目的]探讨磁共振成像(MRI)在肝门区肿瘤的诊断及术前评估的价值。
[材料及方法]分析52例肝门区肿瘤(其中肝细胞癌(HCC)8例,胆管癌(HC)24例,转移性病变12例,血管瘤8例)的MRI表现,MRI检查包括平扫、MRCP、全肝动态增强扫描、三维动态增强磁共振血管成像(3D DCE-MRA),MRI表现与手术、病理结果及其他影像学资料相比较。
[结果](1)MRCP对肝门部胆管梗阻水平定位准确率为90.4%(47/52)。(2)HC的强化类型以门静脉期、延迟期强化为主(19/24,79.2%),HCC的强化类型中动脉期强化,门脉期及延时期强化消退者占50%(4/8),肝门转移性病变12例的强化类型呈多样化,8例血管瘤强化类型以动脉期、门静脉期、延迟期均强化为主(6/8,75%)。(3)HC组48支门静脉中,9支(18.6/%)局部管壁浸润,11支(22.9%)门静脉闭塞,门静脉瘤栓1例;HCC组16支门静脉中,4支(25%)门静脉癌栓,3支(18.8/%)门静脉侧壁虫噬样侵犯;肝门转移性病变组门静脉中仅有3支浸润、缩窄表现;8例血管瘤16支门静脉中分支受挤压、推移8支。(4)3种MRI检查组合方式(第1种:平扫+MRCP;第2种:“1”+全肝动态增强扫描;第3种:“2”+3DDCE-MRA)对肝门区肿瘤定性诊断准确率分别为53.8%,71.2%,80.8%,联合应用MRI检查方法对病变术前能否切除的评估准确率为77.5%(31/40)。
[结论]MRCP对肝门区肿瘤致胆管梗阻水平的定位准确率较高,三维动态增强磁共振血管成像(3D DCE-MRA)能显示不同类型肝门区肿瘤的门静脉改变特点,联合应用MRI平扫、MRCP、动态增强及3D DCE-MRA检查方法对不同类型肝门区肿瘤定位和定性诊断及术前评估较单独一种方法有较高准确率。
[Objective]To investigate the value of MR scanning in the diagnosis and preoperative evaluation of hepatic hilar carcinomar。
[Methods]The appearance of MRI in 52 cases of hepatic hilar carcinomar was analyzed,including hepatocellular carcinoma(HCC,n = 8),hilar cholangiocarcinoma(HC,n=24),hilar metastasis(n = 12),and hemangioma(n=8)。MRI scanning besides the precontrast MRI,MRCP,dynamic contrast-enhanced MR scanning and 3D DCE-MRA。MRI appearance was compared with the results of pathology or surgery or other imaging data。
[Results](1)MRCP could confirm the level of bile duct obstruction with accuracy of 90.4%(47/52)。(2)HC group enhanced in portal vein or delayed period(19/24 79.2%),and half of HCC group began to enhance in arterial period,but disappeared to enhance in portal vein period,and the contrast type of metastasis was various,whereas hemangioma enhanced in arterial and portal vein and delayed period(6/8,,75%)。(3)The portal vein invasion in HC group showed portal vein infiltration(9/48,18.6%), portal vein occlusion(11/48,22.9%),occlusion by tumor thrombosis。all metastasis showed infiltration or central narrowing only in 3 branchs of portal vein。Hemangioma group showed compression and displacement(8/16,50%)。(4)Three kinds of MRI scanning method:[1]precontrast +MRCP;[2]"1" + dynamic contrast-enhanced scanning;[3]"2"+3D DCE-MRA,the accuracy of three kinds of scanning method in qualitative diagnosis of all cases was 53.8%,71.2%,80.8%, respectively。The accurracy of combined application of MR scanning in preoperative evaluation in hepatic hilar tumor was 77.5%(31/40)。
[Conclusion]:The accuracy of MRCP which confirm the level of bile duct obstruction is higher,3D DCE-MRA could show the change of portal vein,the combined application of MR scanning-method,including precontrast MR,MRCP, dynamic contrast-enhanced MR scanning,3D DCE-MRA,could give more accurate information about diagnosis of locational and qualitative and preoperative evaluation in different type of of hepatic hilar tumor than a single scanning-method。
[材料及方法]分析52例肝门区肿瘤(其中肝细胞癌(HCC)8例,胆管癌(HC)24例,转移性病变12例,血管瘤8例)的MRI表现,MRI检查包括平扫、MRCP、全肝动态增强扫描、三维动态增强磁共振血管成像(3D DCE-MRA),MRI表现与手术、病理结果及其他影像学资料相比较。
[结果](1)MRCP对肝门部胆管梗阻水平定位准确率为90.4%(47/52)。(2)HC的强化类型以门静脉期、延迟期强化为主(19/24,79.2%),HCC的强化类型中动脉期强化,门脉期及延时期强化消退者占50%(4/8),肝门转移性病变12例的强化类型呈多样化,8例血管瘤强化类型以动脉期、门静脉期、延迟期均强化为主(6/8,75%)。(3)HC组48支门静脉中,9支(18.6/%)局部管壁浸润,11支(22.9%)门静脉闭塞,门静脉瘤栓1例;HCC组16支门静脉中,4支(25%)门静脉癌栓,3支(18.8/%)门静脉侧壁虫噬样侵犯;肝门转移性病变组门静脉中仅有3支浸润、缩窄表现;8例血管瘤16支门静脉中分支受挤压、推移8支。(4)3种MRI检查组合方式(第1种:平扫+MRCP;第2种:“1”+全肝动态增强扫描;第3种:“2”+3DDCE-MRA)对肝门区肿瘤定性诊断准确率分别为53.8%,71.2%,80.8%,联合应用MRI检查方法对病变术前能否切除的评估准确率为77.5%(31/40)。
[结论]MRCP对肝门区肿瘤致胆管梗阻水平的定位准确率较高,三维动态增强磁共振血管成像(3D DCE-MRA)能显示不同类型肝门区肿瘤的门静脉改变特点,联合应用MRI平扫、MRCP、动态增强及3D DCE-MRA检查方法对不同类型肝门区肿瘤定位和定性诊断及术前评估较单独一种方法有较高准确率。
[Objective]To investigate the value of MR scanning in the diagnosis and preoperative evaluation of hepatic hilar carcinomar。
[Methods]The appearance of MRI in 52 cases of hepatic hilar carcinomar was analyzed,including hepatocellular carcinoma(HCC,n = 8),hilar cholangiocarcinoma(HC,n=24),hilar metastasis(n = 12),and hemangioma(n=8)。MRI scanning besides the precontrast MRI,MRCP,dynamic contrast-enhanced MR scanning and 3D DCE-MRA。MRI appearance was compared with the results of pathology or surgery or other imaging data。
[Results](1)MRCP could confirm the level of bile duct obstruction with accuracy of 90.4%(47/52)。(2)HC group enhanced in portal vein or delayed period(19/24 79.2%),and half of HCC group began to enhance in arterial period,but disappeared to enhance in portal vein period,and the contrast type of metastasis was various,whereas hemangioma enhanced in arterial and portal vein and delayed period(6/8,,75%)。(3)The portal vein invasion in HC group showed portal vein infiltration(9/48,18.6%), portal vein occlusion(11/48,22.9%),occlusion by tumor thrombosis。all metastasis showed infiltration or central narrowing only in 3 branchs of portal vein。Hemangioma group showed compression and displacement(8/16,50%)。(4)Three kinds of MRI scanning method:[1]precontrast +MRCP;[2]"1" + dynamic contrast-enhanced scanning;[3]"2"+3D DCE-MRA,the accuracy of three kinds of scanning method in qualitative diagnosis of all cases was 53.8%,71.2%,80.8%, respectively。The accurracy of combined application of MR scanning in preoperative evaluation in hepatic hilar tumor was 77.5%(31/40)。
[Conclusion]:The accuracy of MRCP which confirm the level of bile duct obstruction is higher,3D DCE-MRA could show the change of portal vein,the combined application of MR scanning-method,including precontrast MR,MRCP, dynamic contrast-enhanced MR scanning,3D DCE-MRA,could give more accurate information about diagnosis of locational and qualitative and preoperative evaluation in different type of of hepatic hilar tumor than a single scanning-method。
引文
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[2]Burke EC,jarnagin WR,Hochwald SN,et al.Hilarcholagiocarcinoma:patterns of spread,the importance of hepaticresection for curative operation,and a persurgical clinical staging system[J].AMJ Surg,1998,228(3):385-394.
[3]Yeh TS,Jan YY,Tseng JH,et al.Malignant perihilar biliary obstruction:magnetic resonance chloangiopancreatographic findings[J].AmJ Gastroenterol,2000,95(2):432-440.
[4]Feydy A,Vilgrain V,Denys A,et al.Helical CT assessment in hilar cholangiocarcinoma:correlation with surgical and pathologicfingings[J].AJR,1999,172(1):73-77
[5]Nishio H,Kamiya J,Nagino M,et al.Valne of percutaneous transhepatic portography before hepatectomy for hilar chloangiocarcinoma[J].Br J Surg,1999,86(11):1415-1421.
[6]刘玉林,孔祥泉,徐海波,等.肝门部胆管癌的MRI应用价值[J]临床放射学杂志,2004,23(3):222-225
[7]严律南主编.肝脏外科.北京:人民卫生出版社,2002,945-948
[8]麻勇,许军,代文杰,肝门部胆管癌诊治进展[J]肝胆胰外科杂志,2005,17(4):343-346
[9]李晓鸥,崔彦,肝门部胆管癌的诊治进展[J].实用医学杂志,2007,23(4):445-447
[10]Bismuth H,castaing D,Traynor O,Resection or palliation:priority of surgery in the treatment of hilar cancer[J].World Surg,1988,12(1):39-47.
[11]刘起旺,钱丽霞,张辉,等,磁共振成像和磁共振胆道成像对肝门部胆管癌诊断和手术可切除性的估价[J].中华普通外科杂志,2001,16(5):294-296
[12]翟立业,杨丽宏,于晓静,等.67例肝门部肿瘤的超声诊断与误诊原因分析[J].实用全科医学,2006,4(3):271-272
[13]LIU Yu-Lin,KONG Xiang-Quan,XU Hai-Bo,et al.evaluation of MRI in Diagnosing Hilar Cholangiocarcinomar[J].The Chinese-German journal of clinical oncology,2005,4(4):201-202
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