| ObjectiveTo discuss the imaging characteristics of different stages of cholangiocarcinoma, according to the WHO histopathologic classification, and to increase the diagnostic accuracy of intrahepatic mass-forming type cholangiocarcinoma, and to expect some help for evaluating the prognosis of the patients.MethodsRetrospectively analyze124cases of intrahepatic mass-forming type cholangiocarcinoma which confirmed by surgery or puncture, the ratio of male/female is67/57, the average onset age is60.4±10.7years. All cases received CEA、AFP、 CA199、CT plain and enhanced scan,69cases received MR plain (include diffusion weighted imaging, DWI) and enhanced scan. The following contents were observed: focal location, appearance (round, lobulated, irregular), size (longest diameter), amount (1,2, multiple, suffusion), boundary, T2WI signal intensity, dynamic contrast enhancement scan mode, and with or without bile duct stone and bile duct dilation, abnormal perfusion, necrosis, liver capsule retraction, target sign on DWI, metastasis (lympha node, liver, vessel encapsulation, extrahepatic organs). Dynamic contrast enhancement scan mode appeared for4types, Type I:ring-like and garland-like marginal enhancement in early phase, and as time goes by centripetal progressive strengthening continuously; Type Ⅱ:whole mass persistently progressive enhancement with slight uniformity or nonuniformity; Type III:mild to moderate marginal enhancement, non-enhanced in most inner, or diffused distribution slight enhancement in great non-enhanced area; Type Ⅳ:obvious enhanced at arterial phase, after then decrease.They were divided into well-differentiated, moderately differentiated and poorly differentiated based on the pathology, then compare them to the imaging characteristics of the IMCC pathological type.Results1. Clinical data.124IMCC cases,67males and57females, male female ratio is1.18:1, There was no statistical significant difference between pathology classify ratio of male and female patients (P>0.05).The average age of well-differentiated, moderately differentiated and poorly differentiated team was62.23±7.45、62.11±10.25and57.76±12.03years, There was no statistical significant different (P>0.05).The CEA、AFP and CA199of different pathology types were no statistical significant difference, but CA199with pathologic classification level was negative correlation, statistics value was2.117, P value was0.347, and other tumor markers were no correlation. 2. Compare the general condition of the tumor to the pathology.58cases located at left liver,43cases at right liver,18cases at both sides,3cases at caudate lobe,2cases at whole liver;62cases were round,36cases were lobulated,26cases were irregular, and the appearances were conformity with pathology appearances.56cases had clear boundary on imaging, then the pathology showed the masses invaded focal surrounding tissue in10cases;68cases had unclear boundary at imaging, then the pathology show the mass invaded surrounding tissue; The average size of the mass(the longest diameter for1mass or the biggest mass for multiple) of well-differentiated、moderately differentiated and poorly differentiated team was (58.92±27.21) mm、(55.32±22.71) mm、(67.06±29.72) mm, there was no statistical significant difference (P>0.05)3:The para-tumor signs. The well-differentiated、moderately differentiated and poorly differentiated team with bile duct stone was5cases、10cases、15cases, there was no statistical significant difference (P>0.05);With bile duct dilation was15cases、31cases、32cases,there was no statistical significant difference (P>0.05); The mass surrounding with abnormal irrigation was15cases、29cases、29cases, there was no statistical significant difference(P>0.05); liver capsule near the mass retraction was19cases、34cases、37cases, then2cases of moderately differentiated team had the liver capsule near the mass swelling, there was no statistical significant difference (P>0.05).4. Tumor density/signal characteristic and dynamic enhanced mode.①26cases of well-differentiated, appeared uniformity or nonuniform low density on CT, single mass for24cases, multiple mass(3-10)for1case, diffused distribution for1case. MR T2WI appeared uniformity high density for8cases, nonuniform high density for4cases, centre relative high density for2cases,12cases received DWI series scan,l case appeared target sign,14cases the focal accompany with necrosis. After enhanced,14cases appeared Type I mode,10cases appear Type Ⅱ mode,2 cases appear Type Ⅲ mode. The pathology shows Type Ⅱ mode has lots tumor cells around the mass, most of the the centre is fiber mesenchymal and fibroblast, few tumor cell.; then Type Ⅱ mode has mixed by tumor cells、fiber mesenchymal and fibroblast around the mass and at the centre of the mass, of which the major was fiber mesenchymal; Type Ⅲ mode is rich in tumor cell around the mass, in the centre of the mass is obvious necrosis, and some tumor call island at necrosis area.②47cases of moderately-differentiated, appears uniformity or nonuniform low density on CT, single mass in28cases,2mass in6cases, multiple mass in9case, diffused distribution for4cases. MR T2WI appears uniformity high density in9cases, nonuniform high density in12cases, centre relative high density in7cases, around relative high density in3cases.28cases received DWI series scan,8case appears target sign,27cases the focal accompany with necrosis. After enhanced,16cases appear Type I mode,17cases appeared Type Ⅱ mode,13cases appeared Type Ⅲ mode,1case appear Type IV mode. The pathology shows Type IV mode has rich in tumor cells, lack of fiber mesenchymal, and uniformity spread.③51cases of poorly-differentiated, appears uniformity or nonuniform low density on CT, single mass in28cases,2mass in3cases, multiple mass in12case, diffused distribution in8case. MR T2WI appears uniformity high density in5cases, nonuniform high density in7cases, centre relative high density in10cases, around relative high density in5cases,29cases received DWI series scan,17cases appeared target sign,38cases accompanied with necrosis. After enhanced,16cases appear Type I mode,14cases appear Type Ⅱ mode,17cases appear Type Ⅲ mode,4case appear Type IV mode. There was no statistical significant different (P>0.05) at the T2WI signal changed between3teams, but at compare2teams, it was statistical significant different (P=0.035) between well-differentiated team and poorly-differentiated team. There was statistical significant different (P=0.005) at DWI series target sign. And no statistical significant different (P>0.05) at the enhanced mode between3teams, but at compare2teams, it was statistical significant different (P=0.023) between well-differentiated team and poorly-differentiated team.5. Metastasis The well-differentiated-. moderately-differentiated and poorly-differentiated team have lympha node metastasis was14cases、36cases、41cases, there was statistical significant different (P=0.048), the rate of metastasis lympha node at cardiodiaphragmatic angle was reach up to48.39%. The well-differentiated%moderately-differentiated and poorly-differentiated team had liver metastases、vessel encapsulation invasion、extrahepatic organs invasion in9cases、25cases、32cases, there was statistical significant difference (P=0.012),the most common was liver metastasis (29.84%)Conclusions1. The IMCC pathology type has certain association with the imageology character:(1) The common character of CT and MRI is:most mass appearance in well-differentiated team is round, then in poorly-differentiated team is lobulated or irregular, and with high lympha node metastasis、liver metastasis、vessel encapsulation invasion and extrahepatic organs invasion;(2) On CT, the well-differentiated team appearance Type Ⅰ and Ⅱ enhanced mode, then the poorly-differentiated team appearance Type Ⅲ and IV enhanced mode, the poorly-differentiated team has high rate of bile duct stone;(3) On MRI, most well-differentiated team appearance T2WI uniformity high density; Then the centre or around relative high density is considered as poorly-differentiated team; poorly-differentiated team has high rate of DWI target sign.2. IMCC often accompany with abnormal irrigation bile duct dilation and liver capsule retraction, but no correlation with pathology classify.3. CA199with pathology classify level was negative correlation, and other tumor marker is no correlation. |
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