Asayama Yoshiki, Nishie Akihiro, Ishigami Kousei, Ushijima Yasuhiro, Takayama Yukihisa, Fujita Nobuhiro, Kubo Yuichiro, Aishima Shinichi, Shirabe Ken, Yoshiura Takashi, Honda Hiroshi
Department of Radiology, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
Diagn Interv Radiol. 2015 Mar-Apr;21(2):96-104. doi: 10.5152/dir.2014.13013.
We aimed to gain further insight in magnetic resonance imaging characteristics of mass-forming intrahepatic cholangiocarcinoma (mICC), its enhancement pattern with gadoxetic acid contrast agent, and distinction from poorly differentiated hepatocellular carcinoma (pHCC).
Fourteen mICC and 22 pHCC nodules were included in this study. Two observers recorded the tumor shape, intratumoral hemorrhage, fat on chemical shift imaging, signal intensity at the center of the tumor on T2-weighted image, fibrous capsule, enhancement pattern on arterial phase of dynamic study, late enhancement three minutes after contrast injection (dynamic late phase), contrast uptake on hepatobiliary phase, apparent diffusion coefficient, vascular invasion, and intrahepatic metastasis.
Late enhancement was more common in mICC (n=10, 71%) than in pHCC (n=3, 14%) (P < 0.001). A fat component was observed in 11 pHCC cases (50%) versus none of mICC cases (P = 0.002). Fibrous capsule was observed in 13 pHCC cases (59%) versus none of mICC cases (P < 0.001). On T2-weighted images a hypointense area was seen at the center of the tumor in 43% of mICC (6/14) and 9% of pHCC (2/22) cases (P = 0.018). Other parameters were not significantly different between the two types of nodules.
The absence of fat and fibrous capsule, and presence of enhancement at three minutes appear to be most characteristic for mICC and may help its differentiation from pHCC.
我们旨在进一步深入了解肿块型肝内胆管癌（mICC）的磁共振成像特征、其使用钆塞酸二钠造影剂的强化模式以及与低分化肝细胞癌（pHCC）的鉴别。
本研究纳入了14个mICC结节和22个pHCC结节。两名观察者记录肿瘤形态、瘤内出血、化学位移成像上的脂肪、T2加权图像上肿瘤中心的信号强度、纤维包膜、动态研究动脉期的强化模式、注射造影剂三分钟后的延迟强化（动态延迟期）、肝胆期的造影剂摄取、表观扩散系数、血管侵犯和肝内转移。
mICC（n = 10，71%）中延迟强化比pHCC（n = 3，14%）更常见（P < 0.001）。11例pHCC病例（50%）观察到脂肪成分，而mICC病例均未观察到（P = 0.002）。13例pHCC病例（59%）观察到纤维包膜，而mICC病例均未观察到（P < 0.001）。在T2加权图像上，43%的mICC（6/14）和9%的pHCC（2/22）病例在肿瘤中心可见低信号区（P = 0.018）。两种类型的结节之间其他参数无显著差异。
无脂肪和纤维包膜以及三分钟时出现强化似乎是mICC最具特征性的表现，可能有助于其与pHCC的鉴别。
