Ros P R, Buck J L, Goodman Z D, Ros A M, Olmsted W W
Department of Radiologic Pathology, Armed Forces Institute of Pathology, Washington, DC.
Radiology. 1988 Jun;167(3):689-93. doi: 10.1148/radiology.167.3.2834769.
Seventeen proved cases of intrahepatic cholangiocarcinoma (ICAC) were reviewed to establish a radiologic-pathologic correlation. The most common appearance of ICAC at computed tomography (CT) is that of a single, homogeneous low-attenuation mass. Multiple low-attenuation lesions were present in four cases. Calcification was depicted by CT in three cases. At angiography, ICAC has a variable appearance with avascular, hypovascular, and hypervascular patterns possible. Portal obstruction was seen in only one case. The most common appearance of ICAC at sonography is that of a homogeneously hyperechoic mass, either single or multiple. In only one case was ICAC hypoechoic. Plain abdominal radiography demonstrated calcification in three patients and evidence of Thorotrast (thorium dioxide) deposition in one. Upper gastrointestinal series demonstrated abnormal gastric folds in two cases, corresponding to gastric invasion by ICAC. There were no characteristic radiographic findings, but the following features may be helpful in differentiating ICAC from other primary intrahepatic tumors, particularly typical hepatocellular carcinoma: a homogeneously echogenic or high-attenuation appearance on images that reflects the uniform nature observed at pathologic examination, the presence of calcification, and the uncommon invasion of portal or hepatic veins. Conversely, the presence of satellite lesions may blur the the distinction between ICAC and metastatic liver disease.
回顾了17例经证实的肝内胆管癌（ICAC）病例，以建立放射学与病理学的相关性。ICAC在计算机断层扫描（CT）上最常见的表现是单个均匀低密度肿块。4例出现多个低密度病变。3例CT显示有钙化。血管造影时，ICAC表现多样，可能有无血管、低血管和高血管模式。仅1例见门静脉阻塞。ICAC在超声检查中最常见的表现是单个或多个均匀高回声肿块。仅1例ICAC为低回声。腹部平片显示3例有钙化，1例有二氧化钍沉积证据。上消化道造影显示2例胃皱襞异常，对应于ICAC侵犯胃。虽无特征性影像学表现，但以下特征可能有助于将ICAC与其他原发性肝内肿瘤，特别是典型肝细胞癌相鉴别：图像上均匀回声或高密度表现反映了病理检查所见的均匀性质、钙化的存在以及门静脉或肝静脉少见的侵犯。相反，卫星灶的存在可能会模糊ICAC与肝转移瘤之间的区别。
