肝内胆管细胞癌的影像表现.ppt

形态学分类 据日本肝癌研究组提出的形态学分类系统，胆管癌可分为肿块型、管周浸润型、胆管内生长型 影像表现-肿块型 好发于肝左叶，引起肝段或肝叶萎缩； CT：稍低密度，界不清，不规则分叶状；病灶内及周围胆管扩张，部分肿块内见低密度的囊变坏死区，少数病灶内高密度；肝脏包膜凹陷、皱缩。 增强：动脉早期周边环形轻中度强化，门静脉期及延迟期出现延迟强化，造影剂逐渐向中央填充。 门静脉瘤栓少见，淋巴结转移多见； 灶周异常灌注；灶周卫星病灶。 肿块型MR T1WI上呈不均匀低信号，少数肿瘤在TlWI上可见斑点状、片状高信号影；T2WI上混杂高或稍高信号，部分中心可见局灶性星芒状、条状或片状低信号 DWI周边高信号 女，79岁，发热，畏冷，腹痛5天 男，47岁，发现肝占位1周 管壁浸润型 狭窄的边缘不规则、不对称缩小胆管，增强强化，淋巴结肿大和导管周围软组织病变，提示恶性狭窄 远端肝内胆管扩张；“软藤状” 富含纤维组织，延迟强化 Figure 9. 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. 男，73岁，乏力，厌油，眼黄一周 管内生长型 弥漫明显胆管扩张伴有肉眼可见乳头状肿块 弥漫性和明显胆管扩张和不可见的肿块 局部胆管扩张内息肉样肿块 轻度扩张管内脱落物样软组织病变 局灶性狭窄病变伴近端胆管轻度扩张 一、弥漫的胆管扩张伴多灶性乳头状或斑块状浅表扩散肿块 Intraductal papillary neoplasm of the biliary tract with marked mucin production.(a, b) Contrast-enhanced CT scan (a) and T2-weighted MR image (b) show a markedly dilated intrahepatic duct with mural nodules or irregular wall thickening (arrow). 二、弥漫性和明显导管扩张和不可见的肿块（微乳头） BilIN-3. (a) Axial contrast-enhanced CT scan shows diffuse ductal dilatation in the left hepatic lobe through the common bile duct, with no visible intraductal mass. (b) Photomicrograph (original magnification,×40; H-E stain) shows micropapillary tumors throughout the bile ducts. These findings are compatible with the micropapillary form of BilIN-3 (carcinoma in situ). Intraductal papillary cholangiocarcinoma. (a) MR cholangiopancreatogram shows an intraductal polypoid mass with localized ductal dilatation (arrow). (b) Photomicrograph (original magnification, ×1; H-Estain) shows an intraductal growth type mass with focal ductal dilatation (arrowheads). 三、局部导管扩张内息肉样肿块 四、轻度扩张胆管内脱落物样软组织病变 Intrad