肝外胆管癌的超声造影灌注特征与增强MRI成像对比研究∗

摘要

Objective To investigate the imaging features of extrahepatic bile duct carcinoma with the real⁃time contrast⁃en⁃hanced ultrasonography(CEUS) and contrast⁃enhanced MRI(CEMRI). Methods A retrospective analysis was made on the imaging features in 56 patients with extrahepatic bile duct carcinoma in our hospital from January 2009 to December 2013, who were confirmed by pathology and examined by CEUS and CEMRI. Results As for CEUS, most of extrahepatic bile duct carcinoma lesions were hyper⁃enhanced(37/56,66�0%) in arterial phase, and hypo⁃enhanced in portal(50/56,89�3%) and late phase(56/56,100%);when at peaking, 34 lesions(34/56) showed diffuse heterogeneous enhancement, and 22(22/56) showed homogeneous enhancement. As for CEMRI, most of extrahepatic bile duct carcinoma lesions were hyper⁃enhanced(37/56,66�0%) in arterial phase, iso⁃enhanced(29/56,51�7%) in portal phase and iso⁃enhanced( 17/56,30�3%) or hyper⁃enhanced( 33/56,58�9%) in late phase;when at peaking, 39 lesions( 39/56) showed diffuse heterogeneous enhancement, and 17( 17/56) showed homogeneous enhancement. The difference of le⁃sion enhancment in arterial phase between CEUS and CEMRI was not sianificant( P>0�05) . But there was a significant difference be⁃tween CEUS and CEMRI on lesion enhancement in portal and late phase( P<0�05);there was no significant difference between CEUS and CEMRI on the number of the lesions showing diffuse homogeneous or heterogeneous enhancement( P>0�05) . Conclusion Com⁃pared with CEMRI, CEUS can observe real⁃time micro perfusion of extrahepatic bile duct carcinoma. For the patients who were highly suspected of extrahepatic bile duct carcinoma, CEUS combined with CEMRI can provide an important imaging evidence for the diagno⁃sis of extrahepatic bile duct carcinoma.%目的：探讨实时超声造影和增强MRI在肝外胆管癌影像学特征。方法回顾性分析对比2009年1月至2013年12月我院收治经手术病理证实的56例肝外胆管癌患者超声造影和增强MRI的影像学特征。结果超声造影显示肝外胆管癌动脉期多为高增强（37／56，66�0％），门脉期（50／56，89�3％）及延迟期（56／56，100％）以回声减低为主；达峰值时，56个病灶中增强不均匀34个，增强均匀22个；增强MRI显示动脉期多为高增强（37／56，66�0％），门脉期一半以上为等增强（29／56，51�7％），延迟期以等增强（17／56，30�3％）或高增强（33／56，58�9％）为主；达峰值时，56个病灶中增强不均匀39个，增强均匀17个。肝外胆管癌超声造影动脉期显示不同增强水平的病灶数与增强MRI比较差异无统计学意义（ P＞0�05）；超声造影门脉期及延迟期与增强MRI增强水平显示的病灶数比较差异有统计学意义（ P＜0�05）；肝外胆管癌中超声造影与增强MRI显示增强均匀性的病灶数比较差异无统计学意义（ P＞0�05）。结论对临床上高度怀疑肝外胆管癌患者，超声造影可作为增强MRI有益补充，为肝外胆管癌的诊断提供重要的影像学依据。