摘要
目的总结肝内胆管囊腺瘤(癌)的超声及超声造影表现,分析其特征及良恶性鉴别点。方法回顾性分析我院经手术病理证实的5例肝内胆管囊腺瘤和5例肝内胆管囊腺癌患者的常规超声和超声造影表现。所有患者肿瘤均为单发。结果 5个肝内胆管囊腺瘤病灶常规超声均表现为囊性或囊实混合且囊/实比例>1,而5个肝内胆管囊腺癌病灶中仅有1个表现为囊性或囊实混合且囊/实比例>1;5个肝内胆管囊腺瘤病灶全部为多房性,而5个肝内胆管囊腺癌病灶中仅有1个病灶为多房性;5个肝内胆管囊腺癌病灶中有4个为实性较多或囊壁见实性结节且结节直径多大于1.0cm,5个肝内胆管囊腺瘤病灶仅有1个出现壁结节,但直径<1.0cm。常规超声检查时,肝内胆管囊腺瘤较肝内胆管囊腺癌更易表现为囊性或囊实混合且囊/实比例>1、多房性、实性成分增多或囊壁、分隔上有实性结节且直径大于1.0cm(Fisher精确概率检验,P均=0.048)。5个肝内胆管囊腺瘤病灶中,3个病灶超声造影动脉期囊壁、分隔或壁上结节表现为高增强,2个病灶表现为等增强,延迟期5个病灶增强部分全部消退为低增强;5个肝内胆管囊腺癌病灶中,3个病灶超声造影动脉期囊壁、分隔或实性部分高增强,2个病灶等增强,延迟期5个病灶增强部分全部消退为低增强。肝内胆管囊腺瘤和肝内胆管囊腺癌在超声造影动脉期及延迟期的增强模式上均无明显差异(Fisher精确概率检验,P=1.00)。5例肝内胆管囊腺瘤患者有4例超声造影诊断正确,而5例肝内胆管囊腺癌患者超声造影均未得到正确诊断。结论肝内胆管囊腺瘤(癌)常规超声表现具有特征性,超声造影能反映囊壁、分隔、实性部分、分隔或壁上结节的血供状态,可作为常规超声检查的有力补充。
Objective To evaluate the imaging features of intrahepatic biliary cystadenoma（cystadenocarcinoma）on baseline and contrast-enhanced ultrasound（CEUS）,and differentiate malignant from benign tumor.Methods The imaging features of 5 intrahepatic biliary cystadenoma cases and 5 intrahepatic biliary cystadenocarcinoma cases were retrospectively analyzed,the diagnosis was proven by pathology after surgical resectionin.All of the lesions were solitary.Results All of the 5 cystadenoma cases were cystic or with an intracystic solid component less than 50%;however,only 1 of the 5 cystadenocarcinoma cases was cystic or intracystic,solid component was less than 50%.All of the 5 cystadenoma cases were multiloculated;only 1 of the 5 cystadenocarcinoma cases was multiloculated.Solid component over 50% or cystic lesions with solid nodules more than 1.0 cm in diameter on the wall were observed in 4 out of 5 cystadenocarcinoma cases.Correspondingly,only 1 out of 5 cystadenoma cases showed mural nodule,but less than 1.0 cm in diameter.On baseline ultrasound,biliary cystadenomas were more likely to be shown as multilocular,cystic lesion or with an intracystic solid component less than 50%,cystadenocarcinomas were more likely to present the features of solid component greater than 50% or mural nodule with a diameter over 1.0 cm.（Fisher exact test,all P=0.048）.On contrast-enhanced ultrasound,hyper-（n=3）or iso-enhancement（n=2）was presented in the cystic wall,septum or mural nodules of the cystadenomas during the arterial phase,the enhancement washed out to be hypo-enhancement in all the lesions during the late phase.Cystadenocarcinomas also showed hyper-（n=3）or iso-enhancement（n=2）in the cystic wall,septum and mural nodules during the arterial phase and hypo-enhancement during the late phase.There was no significant difference between cystadenoma and cystadenocarcinoma in the enhancement pattern of arterial and late phases（Fisher exact test,both P=1.00）.Four in 5 cystadenoma cases were correctly diagnosed on CEUS,but none in cystadenocarcinoma cases.Conclusions Intrahepatic biliary cystadenoma（cystadenocarcinoma）has characteristic features on baseline ultrasound.CEUS,as a solid supplement of baseline ultrasound,is helpful in evaluating the cystic wall,septation,solid component and nodule vascularity.
出处
《中华医学超声杂志（电子版）》
2012年第1期7-11,F0003,共6页
Chinese Journal of Medical Ultrasound(Electronic Edition)
基金
教育部新世纪优秀人才支持计划项目(NCET-06-0723)
上海市卫生局重点项目(2011003)
关键词
超声检查
造影剂
肝内胆管囊腺瘤
肝内胆管囊腺癌
Ultrasonography
Contrast media
Intrahepatic biliary cystadenoma
Intrahepatic biliary cystadenocarcinoma
