（医学课件）医学影像学诊断.ppt

Cholangiocarcinoma Arises from the bile duct epithelium The second most liver cancer after HCC Associated with clonorchiasis, intrahepatic stone disease, choledochal cyst, Caroli disease, and primary sclerosing cholangitis Classified into three types Extrahepatic Peripheral intrahepatic Hilar intrahepatic (Klatskin tumor) * 原发性肝内胆管癌 * Illustration of cholangiocarcinoma Mass-forming intrahepatic cholangiocarcinoma A round mass with a distinct border in the liver parenchyma * Illustration of cholangiocarcinoma Periductal infiltrating intrahepatic cholangiocarcinoma Tumor infiltration along the bile duct Occasionally involves the surrounding blood vessels or hepatic * Illustration of cholangiocarcinoma Intraductal intrahepatic cholangiocarcinoma Papillary or granular growth within bile duct lumen Occasionally demonstrates superficial extension or forms a tumor thrombus in an obstructed duct * Mass-forming cholangiocarcinoma Arterial-phase shows a low-attenuation mass with rim enhancement. Note the dilatation of the peripheral intrahepatic ducts. Portal-phase CT , the mass looks smaller because the central portion is now more enhanced. The rim enhancement seen in a is partially washed out. Capsular retraction is also noted. Photograph of the pathologic specimen obtained at segmentectomy reveals a lobulated, yellow-white mass without encapsulation. Note also the markedly thickened bile duct walls caused by periductal fibrosis, which is a common finding in clonorchiasis. * Intraductal cholangiocarcinoma M53 * Intraductal cholangiocarcinoma and mass-forming cholangiocarcinoma with an intraductal component M78 * Periductal infiltrating cholangiocarcinoma M54 Segmental dilatation of the intrahepatic duct in segment III only. Multiple filling defects representing intrahepatic duct stones 1 cm inferior shows a low-attenuation mass anterior to the left portal vein PTC shows a short narrowed segment at the B3 orifice. Multipl