Shi S, Wang M L, Chen L L, Ji Y, Zeng M S
Department of Radiology, The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou 350004, China Department of Radiology, Zhongshan Hospital, Fudan University, Department of Radiology, Shanghai Geriatric Medical Center, Shanghai 200032, China.
Department of Radiology, Zhongshan Hospital, Fudan University, Department of Radiology, Shanghai Geriatric Medical Center, Shanghai 200032, China.
Zhonghua Gan Zang Bing Za Zhi. 2022 Nov 20;30(11):1188-1193. doi: 10.3760/cma.j.cn501113-20211123-00573.
To investigate the MRI manifestations of lymphoepithelioma-like intrahep cholangiocarcinoma (LEL-ICC). MR images of 26 cases with LEL-ICC confirmed pathologically at Zhongshan Hospital Affiliated with Fudan University between March 2011 and March 2021 were retrospectively analyzed. The number, location, size, morphology, edges of lesions, non-scan signal intensity, cystic necrosis, enhancement mode, peak, and capsule, vascular invasion, lymph node metastasis, and other MR images were included for analysis. The apparent diffusion coefficient (ADC) value of the lesion and the surrounding normal liver parenchyma were measured. A paired-sample -test was used to statistically analyze the measurement data. All 26 cases of LEL-ICC had solitary lesions. Mass-type LEL-ICC was the most common [=23, lesion size (4.02±2.32) cm] with distribution along the bile duct [=3, lesion size (7.23±1.40 cm)]. Among the 23 lesions of mass type LEL-ICC, most of the lesions were close to the liver capsule (=20), round (=22), clearly bordered (=13), and cystic necrosis (=22). In the three lesions of LEL-ICC distributed along the bile duct, most of them were close to the liver capsule (=2), irregular (=3), blurred edges (=3), and cystic necrosis (=3). All 26 lesions showed a low/slightly low signal on TWI, a high/slightly high signal on TWI, and a slightly high or high signal on DWI. Three lesions showed fast-in and fast-out enhancement modes, and 23 lesions showed continuous enhancement. Twenty-five lesions showed peak enhancement in the arterial phase, and one lesion appeared in the delayed phase. The ADC value of 26 lesions and adjacent normal liver parenchyma was (1.112±0.274)×10 mm/s and (1.482±0.346)×10 mm/s, respectively, and the both had a statistically significant difference (<0.05). Certain manifestations of LEL-ICC in magnetic resonance imaging are advantageous for diagnosis and differential diagnosis.
探讨淋巴上皮瘤样肝内胆管癌（LEL-ICC）的MRI表现。回顾性分析2011年3月至2021年3月在复旦大学附属中山医院经病理证实的26例LEL-ICC患者的MR图像。分析病变的数量、位置、大小、形态、边缘、平扫信号强度、囊变坏死、强化方式、强化峰值及包膜、血管侵犯、淋巴结转移等MR表现。测量病变及周围正常肝实质的表观扩散系数（ADC）值。采用配对样本t检验对测量数据进行统计学分析。26例LEL-ICC均为单发病变。肿块型LEL-ICC最为常见[23例，病变大小（4.02±2.32）cm]，沿胆管分布3例[病变大小（7.23±1.40）cm]。在23例肿块型LEL-ICC病变中，多数病变靠近肝包膜（20例），圆形（22例），边界清晰（13例），有囊变坏死（22例）。在3例沿胆管分布的LEL-ICC病变中，多数靠近肝包膜（2例），形态不规则（3例），边缘模糊（3例），有囊变坏死（3例）。26例病变T1WI均呈低/稍低信号，T2WI呈高/稍高信号，DWI呈稍高或高信号。3例呈快进快出强化方式，23例呈持续强化。25例病变动脉期强化峰值出现，1例延迟期出现。26例病变及相邻正常肝实质的ADC值分别为（1.112±0.274）×10⁻³mm²/s和（1.482±0.346）×10⁻³mm²/s，两者差异有统计学意义（P<0.05）。LEL-ICC在磁共振成像中的某些表现有利于诊断和鉴别诊断。
