From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.Z., M.J.H.); Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Tex (D.C.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (N.Y.); Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy & Université de Paris, Paris, France (M.R.); Department of Radiology, Weill Cornell Medicine, New York, NY (E.M.H.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, General Hospital of Vienna (AKH), Vienna, Austria (N.B., A.B.S.); Departments of Radiology and Medicine, Duke University Medical Center, Durham, NC (M.R.B.); and Department of Radiology, UC San Diego School of Medicine, San Diego, Calif (K.F.).
Radiographics. 2022 Sep-Oct;42(5):1320-1337. doi: 10.1148/rg.210194. Epub 2022 Aug 5.
Biliary malignancies include those arising from the intrahepatic and extrahepatic bile ducts as well as the gallbladder and hepatopancreatic ampulla of Vater. The majority of intrahepatic and extrahepatic malignancies are cholangiocarcinomas (CCAs). They arise owing to a complex interplay between the patient-specific genetic background and multiple risk factors and may occur in the liver (intrahepatic CCA), hilum (perihilar CCA), or extrahepatic bile ducts (distal CCA). Biliary-type adenocarcinoma constitutes the most common histologic type of ampullary and gallbladder malignancies. Its prognosis is poor and surgical resection is considered curative, so early detection is key, with multimodality imaging playing a central role in making the diagnosis. There are several risk factors for biliary malignancy as well as predisposing conditions that increase the risk; this review highlights the pertinent imaging features of these entities with histopathologic correlation. The predisposing factors are broken down into three major categories: congenital malformations such as choledochal cyst and pancreaticobiliary maljunction; infectious or inflammatory conditions such as parasitic infections, hepatolithiasis, primary sclerosing cholangitis, and porcelain gallbladder; and preinvasive epithelial neoplasms such as biliary intraepithelial neoplasm, intraductal papillary neoplasm of the bile duct, intra-ampullary papillary tubular neoplasm, and intracholecystic papillary neoplasm of the gallbladder. Recognizing the baseline features of these premalignant biliary entities and changes in their appearance over time that indicate the advent of malignancy in high-risk patients can lead to early diagnosis and potentially curative management. RSNA, 2022.
胆道恶性肿瘤包括源自肝内和肝外胆管、胆囊和胰胆管壶腹的恶性肿瘤。大多数肝内和肝外胆管恶性肿瘤为胆管癌（CCA）。它们是由于患者特定的遗传背景和多种风险因素的复杂相互作用而产生的，可能发生在肝脏（肝内 CCA）、肝门（肝门部 CCA）或肝外胆管（远端 CCA）。胆管型腺癌构成壶腹和胆囊恶性肿瘤最常见的组织学类型。其预后较差，手术切除被认为是治愈性的，因此早期发现是关键，多模态成像在做出诊断中起着核心作用。胆道恶性肿瘤有几个危险因素和增加风险的易患情况；这篇综述强调了这些病变的相关影像学特征，并与组织病理学进行了关联。易患因素分为三大类：先天性畸形，如胆总管囊肿和胰胆管合流异常；感染或炎症性疾病，如寄生虫感染、胆石症、原发性硬化性胆管炎和瓷化胆囊；以及上皮前肿瘤，如胆管上皮内瘤变、胆管内乳头状肿瘤、壶腹内乳头状管状肿瘤和胆囊内乳头状肿瘤。认识这些癌前胆道病变的基线特征以及高危患者中提示恶性肿瘤出现的外观变化，可以实现早期诊断和潜在的治愈性治疗。放射学学会，2022 年。
