Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
AJR Am J Roentgenol. 2021 Feb;216(2):403-411. doi: 10.2214/AJR.20.22768. Epub 2020 Dec 23.
The purpose of our study was to identify the imaging features that differentiate a hepatic mucinous cystic neoplasm (MCN) from a simple biliary cyst. Surgically resected hepatic MCNs and simple biliary cysts over a 20-year period (October 29, 1997-January 23, 2018) with preoperative CT, MRI, or both were retrospectively identified. Included cases underwent histopathologic confirmation of diagnosis based on the 2010 World Health Organization criteria and blinded imaging review. Various imaging features, including cyst shape and septal enhancement, were assessed for performance. For septate cysts, the relationship of the septation to the cyst wall-that is, arising from the wall without an indentation versus arising from an external macrolobulation-was recorded. Statistical analysis was performed for the imaging features with the chi-square test. The study group comprised 22 hepatic MCNs and 56 simple biliary cysts. A unilocular hepatic cystic lesion was highly predictive of a simple biliary cyst (positive predictive value = 95.2%). The imaging feature of septations arising only from macro-lobulations was 100% specific for a simple biliary cyst on CT ( = 0.001). The presence of septations arising from the cyst wall without indentation was 100% sensitive for hepatic MCN but was only 56.3% specific on CT. Septal enhancement reached 100% sensitivity for hepatic MCN on MRI ( = 0.018). The presence of septations, relationship of the septations to the cyst wall, and septal enhancement were sensitive imaging features in the detection of hepatic MCN. The imaging feature of septations arising only from macrolobulations in the cyst wall was specific for simple biliary cysts on CT and helped differentiate simple biliary cysts from hepatic MCNs.
我们的研究目的是确定鉴别肝黏液性囊性肿瘤（MCN）与单纯胆管性囊肿的影像学特征。回顾性分析了 20 年间（1997 年 10 月 29 日至 2018 年 1 月 23 日）经手术切除的肝 MCN 和单纯胆管性囊肿的术前 CT、MRI 或两者的影像学资料。纳入的病例均根据 2010 年世界卫生组织标准进行了组织病理学诊断，并进行了盲法影像学检查。评估了各种影像学特征，包括囊肿形状和分隔增强，以评估其表现。对于分隔囊肿，记录分隔与囊肿壁的关系，即是否从无凹陷的壁上发出，还是从外部大分叶上发出。对具有统计学意义的影像学特征进行了卡方检验。研究组包括 22 例肝 MCN 和 56 例单纯胆管性囊肿。单房性肝囊性病变高度提示为单纯胆管性囊肿（阳性预测值=95.2%）。CT 上仅见大分叶上发出的分隔的影像学特征对单纯胆管性囊肿具有 100%的特异性（ = 0.001）。从无凹陷的囊肿壁上发出分隔的存在对肝 MCN 具有 100%的敏感性，但在 CT 上仅具有 56.3%的特异性。MRI 上分隔增强对肝 MCN 的敏感性达到 100%（ = 0.018）。分隔的存在、分隔与囊肿壁的关系以及分隔增强是肝 MCN 检测的敏感影像学特征。CT 上仅见囊肿壁上大分叶发出的分隔的影像学特征对单纯胆管性囊肿具有特异性，有助于鉴别单纯胆管性囊肿和肝 MCN。
