發(fā)布時(shí)間：2018-05-18 08:27

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

【摘要】：目的：分析腫塊型肝內(nèi)膽管細(xì)胞癌(intrahepatic cholangiocarcinoma，ICC)的MRI表現(xiàn)，探討MRI平掃、動(dòng)態(tài)增強(qiáng)及DWI對(duì)ICC的診斷和鑒別診斷的臨床價(jià)值。 資料和方法：分析50例我院經(jīng)病理證實(shí)的肝臟膽管細(xì)胞癌患者的MRI影像學(xué)資料，所有患者術(shù)前均應(yīng)用PhilipsAchieva1.5T MR或Siemens Verio3.0T掃描儀進(jìn)行常規(guī)的MR平掃、動(dòng)態(tài)增強(qiáng)及DWI檢查。觀察、分析MRI平掃征象及動(dòng)態(tài)增強(qiáng)各期病灶的強(qiáng)化特點(diǎn)，對(duì)ICC影像特點(diǎn)如病灶形態(tài)、信號(hào)、增強(qiáng)的強(qiáng)化方式以及有無膽管擴(kuò)張、肝包膜皺縮、肝葉萎縮，血管受侵程度、是否出現(xiàn)肝門區(qū)、腹膜后淋巴結(jié)轉(zhuǎn)移情況進(jìn)行分析。測(cè)量病灶邊緣部分即早期強(qiáng)化處、病灶中央延遲強(qiáng)化區(qū)域以及同組患者正常肝組織ADC值，進(jìn)行統(tǒng)計(jì)分析。 結(jié)果：(1)常規(guī)的MR平掃，，50例患者病灶均表現(xiàn)為不均勻或均勻的稍低T1、混雜T2信號(hào)，其中8例T2WI上病灶中心可見局灶性星芒狀或片狀低信號(hào)。（2）增強(qiáng)掃描，有25例病灶動(dòng)脈期病灶邊緣呈厚或薄環(huán)狀、花環(huán)狀強(qiáng)化，門脈期、延遲期對(duì)比劑逐漸向病灶內(nèi)填充，強(qiáng)化范圍增大，呈不均勻斑片狀強(qiáng)化，部分呈網(wǎng)格狀強(qiáng)化；19例病灶動(dòng)脈期呈不均勻輕中度斑片狀強(qiáng)化，延遲期強(qiáng)化范圍增大，其中7例早期強(qiáng)化部分延遲期強(qiáng)化程度有所下降；4例病灶動(dòng)脈期未見明顯強(qiáng)化者，靜脈期、延遲期病灶漸進(jìn)性、向心性強(qiáng)化；有2例患者出現(xiàn)明顯較均勻強(qiáng)化，延遲掃描強(qiáng)化程度輕度減退，仍呈相對(duì)高信號(hào)，病灶中央可見小斑點(diǎn)狀低信號(hào)。（3）ICC的DWI呈不均勻稍高或高信號(hào)，腫瘤邊緣部分即早期強(qiáng)化處、病灶中央延遲強(qiáng)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(jì)學(xué)意義（P＜0.05）。 結(jié)論：T2WI中心可見局灶性星芒狀或片狀低信號(hào)，增強(qiáng)掃描病灶周邊早期強(qiáng)化部分在延遲時(shí)可出現(xiàn)強(qiáng)化程度減低，腫塊周邊早期強(qiáng)化部分DWI呈高信號(hào)，ADC值下降，這些特征征象對(duì)ICC的MRI影像定性診斷和鑒別診斷具有重要的參考價(jià)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(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.2;R735.8

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