肝内胆管细胞癌超声造影表现

摘要

目的总结肝内胆管细胞癌的超声造影表现。方法回顾性分析2009年1月至2011年12月复旦大学附属中山医院收治的经手术及穿刺活检病理证实的56例肝内胆管细胞癌患者超声造影表现。结果56例肝内胆管细胞癌患者共70个病灶，所有病灶超声造影均表现为“快进快出”，门脉期及延迟期均呈低回声。肝内胆管细胞癌超声造影开始增强时间、达峰时间、表现为等回声时间、表现为低回声时间分别为（14．50±3．82）s、（22．29±4．97）s、（30．38±7．97）s、（43．54±16．80）s。70个病灶中，42个（60．0％，42／70）表现为动脉期病灶边缘不规则环状增强，28个（40．0％，28／70）表现为整体增强；动脉期增强过程中，49个病灶（70．0％，49／70）表现为“树枝状”由周边向中央延伸的特征性的增强方式。超声造影增强达峰值时，51个病灶（72．9％，51／70）表现为不均匀增强，19个（27．1％，19／70）表现为均匀增强。21个病灶（30．0％，21／70）常规二维超声检查病灶边界显示不清，超声造影病灶边界均清晰。所有病灶在门脉期及延迟期均表现为低回声。56个病灶（80．0％，56／70）超声造影表现为“快进快出”、环状增强和（或）树枝状增强。结论肝内胆管细胞癌的超声造影具有“快进快出”、环状增强和（或）树枝状增强等表现，对其诊断和鉴别诊断具有一定的价值。%Objective To investigate the diagnostic value of contrast-enhanced ultrasonography (CEUS ) for peripheral intrahepatic cholangiocarcinoma .Methods Fifty-six cholangiocarcinoma cases confirmed by pathology in Zhongshan Hospital of Fudan University had been analyzed retrospectively .Results All lesions manifested“fast in and fast out”after contrast injection and hypoechoic in portal and delayed phase.The enhancement start time,peak time,time to isoechogenity and hypoechogenity was (14.50 ±3.82) s,(22.29 ±4.97)s,(30.38 ±7.97) s and (43.54 ±16.80) s,respectively.Forty-two lesions (60.0%, 42/70)showed irregular rim-like enhancement while the rest (40.0%,28/70)showed gross enhancement. During the arterial phase,a characteristic pattern“branch enhancement” ( from periphery to centre ) was observed in 49 lesions (70.0%,49/70).At peak intensity,51 tumors (72.9%,51/70)were inhomogeneous and 19 (27.1%,19/70)were homogeneous.The boundary of lesions was unclear in conventional ultrasound and became distinct after contrast injection.Conclusions In CEUS,peripheral intrahepatic cholangiocarcinoma shows“fast in and fast out”,rim-like enhancement and/or branch enhancement.CEUS can help to diagnose of peripheral intrahepatic cholangiocarcinoma .