导管内息肉样肿块的超声特征：肝细胞癌与导管内胆管癌的鉴别

Sonographic features of an intraductal polypoid mass: differentiation between hepatocellular carcinoma and intraductal cholangiocarcinoma.

作者信息

Kim Na Ra, Kim Se Hyung, Lee Jeong Min, Lee Kyoung Ho, Kim Young Jun, An Su Kyung, Jung Ah Young, Han Joon Koo, Choi Byung Ihn

机构信息

Department of Radiology, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea.

出版信息

J Ultrasound Med. 2004 Oct;23(10):1283-91. doi: 10.7863/jum.2004.23.10.1283.

DOI:10.7863/jum.2004.23.10.1283

PMID:15448317

Abstract

OBJECTIVE

To identify laboratory and sonographic features capable of differentiating hepatocellular carcinoma (HCC) invading the bile duct from intraductal cholangiocarcinoma (IDCCC).

METHODS

Nine patients with HCC invading the bile duct and 8 patients with IDCCC were found in our radiologic and pathologic database. Laboratory (alpha-fetoprotein, cancer antigen 19-9, total bilirubin, and alkaline phosphatase) and sonographic findings were retrospectively reviewed by 2 reviewers by consensus. Sonographic findings included the presence and echo texture of parenchymal masses, the margin and echo texture of intraductal masses, continuity between parenchymal and intraductal masses, cystic ductal dilatation or wall thickening of the bile duct, and the presence of associated chronic liver disease.

RESULTS

Significant differences were found in the levels of total bilirubin (14 versus 3.5 mg/dL), alpha-fetoprotein (2984 versus 5 ng/mL), and cancer antigen 19-9 (8574 versus 1861 U/mL) in HCC and IDCCC (P <.05). Echogenicity of the intraductal masses was iso or low in 8 (88.9%) of 9 HCCs and 3 (37.5%) of 8 IDCCCs (P <.05). In all 7 patients with HCC but in no patient with IDCCC, the parenchymal masses were contiguous with the intraductal masses (P <.05). Cystic ductal dilatation of bile duct was seen in 8 (88.9%) of 9 HCCs and 3 (37.5%) of 8 IDCCCs (P <.05). All 9 (100%) of 9 HCCs and 3 (37.5%) of 8 IDCCCs were associated with chronic liver disease (P <.05). Parenchymal masses occurred in 7 patients with HCC (77.8%) and in 3 patients with IDCCC (37.5%), but the difference was not statistically significant (P =.153). The margins of the intraductal masses were smooth in all 9 (100%) of 9 HCCs and lobulated in 3 (37.5%) of 8 IDCCCs (P =.082).

CONCLUSIONS

Combined interpretation of laboratory and sonographic features may help in the differentiation of HCC with bile duct invasion and IDCCC.

摘要

目的

确定能够区分侵犯胆管的肝细胞癌（HCC）与导管内胆管癌（IDCCC）的实验室及超声特征。

方法

在我们的放射学和病理学数据库中发现了9例侵犯胆管的HCC患者和8例IDCCC患者。两名研究者通过共识对实验室检查结果（甲胎蛋白、癌抗原19-9、总胆红素和碱性磷酸酶）及超声检查结果进行了回顾性分析。超声检查结果包括实质肿块的存在及回声质地、导管内肿块的边界及回声质地、实质与导管内肿块的连续性、胆管的囊性扩张或壁增厚，以及是否存在相关慢性肝病。

结果

HCC和IDCCC患者的总胆红素水平（14对3.5mg/dL）、甲胎蛋白（2984对5ng/mL）和癌抗原19-9（8574对1861U/mL）存在显著差异（P<.05）。9例HCC中的8例（88.9%）和8例IDCCC中的3例（37.5%）导管内肿块呈等回声或低回声（P<.05）。在所有7例HCC患者中，实质肿块与导管内肿块相连，而在IDCCC患者中无一例如此（P<.05）。9例HCC中的8例（88.9%）和8例IDCCC中的3例（37.5%）可见胆管的囊性扩张（P<.05）。所有9例（100%）HCC和8例IDCCC中的3例（37.5%）与慢性肝病相关（P<.05）。7例（77.8%）HCC患者和3例（37.5%）IDCCC患者出现实质肿块，但差异无统计学意义（P=.153）。9例HCC中的所有9例（100%）导管内肿块边界光滑，8例IDCCC中的3例（37.5%）呈分叶状（P=.082）。