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目的分析外周型肝内胆管细胞癌(PCC)的MRI表现及其误漏诊原因。方法回顾性分析8例MR检查被误漏诊的PCC,均经手术病理证实,所有病例均做了MRI平扫、磁共振胰胆管造影(MRCP)和动脉期、门脉期、延迟期增强扫描。结合手术及病理所见分析其MRI表现及误诊原因。结果 8例PCC磁共振成像均未显示具体肿块影,肝左叶胆管走向僵直、截断及病灶内胆管扩张。平扫T1WI见低信号灶,T2WI信号改变不明显,弥散加权像(DWI)呈高信号;增强扫描动脉期病灶无强化,门脉期、平衡期及延迟期均呈不均匀轻/中度强化。其他表现包括肝内小转移灶3例,腹膜后淋巴结转移者5例,均无门静脉癌栓。结论 MRI检查信号改变、强化特征不明显的PCC极易误诊,需仔细观察胆管扩张的形态改变及动态增强特点,结合DWI像做出诊断。
Objective To analyze the MRI findings and causes of misdiagnosis in peripheral intrahepatic cholangiocellular carcinoma (PCC). Methods Retrospective analysis of 8 cases of missed diagnosis of PCC by MR examination were confirmed by operation and pathology. All patients underwent MRI scan, MRCP and arterial phase, portal phase, delayed phase enhanced scan. According to the results of surgery and pathology, the MRI findings and causes of misdiagnosis were analyzed. Results 8 cases of PCC magnetic resonance imaging did not show the specific mass of the lesion, the left bile duct of the liver to stiff, truncated and intrahepatic bile duct dilatation. In plain T1WI, low signal lesions were seen, while T2WI signals did not change significantly. DWI showed high signal intensity. No enhancement was seen in enhanced scan arterial lesions, and non-uniform light / moderate enhancement in portal vein phase, balance phase and delay phase . Other manifestations include small intrahepatic metastases in 3 cases, retroperitoneal lymph node metastasis in 5 cases, no portal vein tumor thrombus. Conclusion The MRI examination of signal changes, enhanced features of PCC is not easy to misdiagnosis, need to carefully observe the morphological changes of bile duct dilatation and dynamic enhancement characteristics, combined with DWI to make a diagnosis.