中国寄生虫学与寄生虫病杂志

• 论著 • 上一篇    下一篇

华支睾吸虫病合并胆管癌的影像学分析

徐世昌1,2,温志波3*   

  1. 1南方医科大学,广州510515;2顺德区北滘医院放射科,佛山528311;3 南方医科大学珠江医院放射科,广州 510282
  • 出版日期:2016-06-30 发布日期:2016-10-28

Imaging Analysis in Cases with Clonorchiasis-Associated Cholangiocarcinoma

XU Shi-chang1,2,WEN Zhi-bo3*   

  1. 1 Southern Medical University, Guangzhou 510515, China;2 Department of Radiology, Shunde District Beijiao Hospital, Foshan 528311, China;3 Department of Radiology, Zhujiang Hospital of Southern Medical University, Guangzhou 510282, China
  • Online:2016-06-30 Published:2016-10-28

摘要: 目的 探讨华支睾吸虫病合并胆管癌的CT、磁共振成像(MRI)影像学特征,为临床诊断提供参考。 方法 收集2005年7月-2015年6月在广东省两个医院60例经手术或穿刺病理证实为胆管癌患者的CT、MRI(包括磁共振胰胆管造影,MRCP)影像学资料,其中华支睾吸虫病合并胆管癌26例(A组),单纯性胆管癌34例(B组)。分析A、B两组患者肿瘤的发生部位,肿瘤病理类型,影像密度及信号特点、强化方式和胆管扩张方式。 结果 影像学检查结果显示,A组患者的肿瘤好发部位为肝右叶(占46.2%,12/26),B组则好发于左肝管及肝总管(占61.8%,21/34)(P<0.05)。A组患者的肿瘤病理类型,结节/肿块型占73.1%(19/26)、浸润型占15.4%(4/26)、腔内生长型占11.5%(3/26),B组则分别占52.9%(18/34)、23.5%(8/34)和23.5%(8/34)(P>0.05)。CT、MRI平扫和增强平扫结果显示,两组患者的肿瘤密度、信号特点及强化方式等没有太多差异。MRCP 检查结果显示,A组患者中,肝内末梢胆管囊状扩张、肝内胆管软藤状扩张、肿瘤病灶内及肿瘤周围胆管扩张分别占61.5%(16/26)、19.2%(5/26)、50%(13/26)和7.7%(2/26),B组则分别占8.8%(3/34)、64.8%(22/34)、20.6%(7/34)和38.2%(13/34),两组胆管的4种扩张方式比较差异有统计学意义(P<0.05)。 结论 华支睾吸虫病合并胆管癌的影像学有一定的特征性表现,肿瘤好发部位和肝内胆管扩张形态特征与单纯性胆管癌的均有所不同。

关键词: 华支睾吸虫病, 胆管癌, 肝, CT, 磁共振成像(MRI), 磁共振胰胆管造影(MRCP)

Abstract: Objective To investigate the magnetic resonance imaging (MRI) and computed tomography(CT) features of clonorchiasis-associated cholangiocarcinoma, and provide reference for its clinical diagnosis. Methods The CT and MRI (including magnetic resonance cholangiopancreatography, MRCP) data of 60 patients diagnosed to have cholangiocarcinoma(26 cases with clonorchiasis-associated cholangiocarcinoma, group A; 34 cases with simple cholangiocarcinomas, group B) by surgery or biopsy in two hospitals in Guangdong Province during July 2005 and June 2015 were collected. The tumor location, pathological types, imaging features, mode of enhancement, and the bile duct expansion were analyzed. Results Imaging results showed that the tumor tended to occur in the right liver in group A(46.2%, 12/26) and in the left hepatic duct and the liver explorer in group B (61.8%, 21/34)(P<0.05). The pathological types of tumor in both groups included the nodule/mass type(group A, 73.1%, 19/26; group B, 52.9%, 18/34), the infiltration type (15.4%, 4/26; 23.5%, 8/34), and the cavity growth type(11.5%, 3/26; 23.5%, 8/34)(P>0.05). Plain and enhanced CT and MRI results revealed no significant difference in tumor density, signal characteristics or the mode of enhancement between the two groups. MRCP results showed that the intrahepatic distal bile duct cystic dilatation, the intrahepatic bile duct cane soft tubular ectasia, the bile duct dilatation in the tumor, and the bile duct dilatation surrounding the tumor accounted for 61.5%(16/26), 19.2% (5/26), 50% (13/26) and 7.7%(2/26) in group A, and 8.8% (3/34), 64.8% (22/34), 20.6% (7/34) and 38.2% (13/34) in group B (P<0.05 for each of the four), respectively. Conclusion The clonorchiasis-associated cholangiocarcinoma has certain imaging characteristics. It is different from the simple cholangiocarcinomas in tumor location and intrahepatic bile duct dilatation.

Key words: Clonorchiasis, Cholangiocarcinomas, Liver, CT, Magnetic resonance imaging, Magnetic resonance cholangiopancreatography