Khot Rachita, Ganeshan Dhakshinamoorthy, Sundaram Karthik M, Depetris Jena N, Ludwig Daniel R
Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA.
Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Abdom Radiol (NY). 2024 Dec 26. doi: 10.1007/s00261-024-04742-6.
Biliary and peribiliary cystic lesions represent a diverse group of abnormalities, often discovered incidentally during imaging for unrelated conditions. These lesions, typically asymptomatic, necessitate precise imaging modalities to characterize their nature and determine subsequent clinical actions, such as follow-up imaging, biopsy, or surgical referral. The anatomic location of these cystic lesions, whether biliary or peribiliary, influences both diagnostic and prognostic outcomes. Biliary cystic lesions, such as mucinous cystic neoplasms, intraductal papillary neoplasms of the bile duct, and Caroli disease, require careful monitoring due to their propensity to develop malignancy. In contrast, peribiliary cysts are often associated with chronic liver disease and may indicate disease progression through a gradual increase in cyst size. Accurate differentiation of these lesions from other clinical entities that have overlapping features on imaging, such as microabscesses, bilomas, Langerhans cell histiocytosis, neurofibromatosis, and vascular anomalies such as cavernous transformation of the portal vein, is essential given the divergent management for each. This article focuses on intrahepatic biliary and peribiliary cystic lesions and their mimics, highlighting their imaging characteristics with an emphasis on magnetic resonance imaging and magnetic resonance cholangiopancreatography, differential diagnosis, potential associated complications, and clinical management.
胆管及胆管周围囊性病变是一组多样的异常情况，常在因无关病症进行影像学检查时偶然发现。这些病变通常无症状，需要精确的影像学检查方法来明确其性质，并确定后续的临床措施，如进一步的影像学检查、活检或转诊手术。这些囊性病变的解剖位置，无论是胆管性还是胆管周围性，都会影响诊断和预后结果。胆管囊性病变，如黏液性囊性肿瘤、胆管内乳头状肿瘤和卡罗利病，由于其恶变倾向，需要仔细监测。相比之下，胆管周围囊肿常与慢性肝病相关，可能通过囊肿大小的逐渐增加提示疾病进展。鉴于这些病变与其他在影像学上有重叠特征的临床实体（如微脓肿、胆汁瘤、朗格汉斯细胞组织细胞增多症、神经纤维瘤病以及门静脉海绵样变等血管异常）的鉴别至关重要，因为它们各自的处理方式不同。本文重点关注肝内胆管及胆管周围囊性病变及其相似病变，突出其影像学特征，重点是磁共振成像和磁共振胰胆管造影、鉴别诊断、潜在相关并发症及临床处理。
