Neoplasma. 2017;64(6):945-953. doi: 10.4149/neo_2017_619.
The aim of this study is to explore the value of unenhanced magnetic resonance imaging (MRI), gadobenate dimeglumine injection (Gd-BOPTA)-enhanced MRI and diffusion-weighted imaging (DWI) in the diagnosis of intrahepatic mass-forming cholangiocarcinoma (IMCC). Totally 59 IMCC patients who underwent Gd-BOPTA-enhanced MRIs were recruited. The time-signal intensity curves and lesion periphery enhancement rates of the IMCC and liver parenchyma was drawn using apparent diffusion coefficient (ADC) values. The Gd-BOPTA-enhanced MRI showed that the peripheries of 30 lesions in the arterial phase exhibited irregular ring enhancement. However, lesions in the portal and delayed phases (which were gradually filled with a contrast agent), presented a patchy or latticed enhancement. Twenty-two lesions in the arterial and delayed phases exhibited uneven mild/moderate patchy enhancements with a progressive and centripetal lesion. Five lesions emerged from the arterial phase without any significant enhancement and had only gradual enhancement during the delayed phase. The remaining 2 lesions had a decreased mild enhancement, presented comparatively high signals and the lesion center had visible small spotted low signals. The DWI signals displayed a slightly high or high unevenness. Some lesion peripheries had a high signal but lesion centers displayed a relatively low or slightly low signal and irregular patches. There were significant differences between the ADC values of the lesion edge, lesion center and liver parenchyma. The IMCC detection rates of the Gd-BOPTA-enhanced MRI and DWI were higher than those of the unenhanced MRI. Our study demonstrated that both the Gd-BOPTA-enhanced MRI and DWI had higher accuracies rates than an unenhanced MRI. Furthermore, the hepatobiliary phase of IMCC plays an important role in the diagnosis and identification of IMCC constituents.
本研究旨在探讨平扫磁共振成像(MRI)、钆贝葡胺注射液(Gd-BOPTA)增强 MRI 和弥散加权成像(DWI)在诊断肝内肿块型胆管细胞癌(IMCC)中的价值。共纳入 59 例接受 Gd-BOPTA 增强 MRI 检查的 IMCC 患者。采用表观扩散系数(ADC)值绘制 IMCC 和肝实质的时间-信号强度曲线和病变周边强化率。Gd-BOPTA 增强 MRI 显示动脉期 30 个病灶的周边呈不规则环形强化,门脉期和延迟期(逐渐填充造影剂)病灶呈斑片状或网状强化。22 个病灶在动脉期和延迟期呈不均匀的轻度/中度斑片状强化,呈渐进性向心性强化。5 个病灶从动脉期开始无明显强化,仅在延迟期逐渐强化。其余 2 个病灶呈轻度减弱,信号较高,病灶中心可见小斑点状低信号。DWI 信号呈稍高或高低不均匀。部分病灶周边呈高信号,但病灶中心呈相对低或稍低信号,呈不规则斑片状。病灶边缘、中心和肝实质的 ADC 值差异有统计学意义。Gd-BOPTA 增强 MRI 和 DWI 的 IMCC 检出率均高于平扫 MRI。本研究表明,Gd-BOPTA 增强 MRI 和 DWI 的检出率均高于平扫 MRI。此外,IMCC 的肝胆期在 IMCC 成分的诊断和鉴别诊断中具有重要作用。