Analysis of the misdiagnosis in intrahepatic cholangiocarcinoma associated with hepatolithiasis by CT/MRI / 实用放射学杂志

ABSTRACT

Objective To analyze the cause of the misdiagnosis of hepatolithiasisGassociated intrahepatic cholangiocarcinoma (IHHCC)by CT/MRI,and to improve early imaging diagnostic rate of IHHCC.Methods Thirteen patients histopathologically confirmed IHHCC after operation were retrospectively analyzed.1 1 cases had CT scans with contrast enhancement.5 cases had MRI scans with contrast enhancement and magnetic resonance cholangiopancreatography(MRCP).Combining with the imaging features of IHHCC (including the soft tissue mass shadow in the bile duct,the dilation and stenosis of the bile duct,the shriveling of the liver capsule,and etc.),medical history and serum tumor markers,misdiagnosis causes were analyzed.Results The causes of misdiagnosed IHHCC(1 )High density bile duct stones in CT imaging concealed the soft tissue of adjacent cholangiocarcinoma;(2)The inconsistence of the degree and location of dilated bile duct with the location and size of bile dult stone was ignored;(3)Soft tissue lesions of cholangiocarcinoma with delayed enhancement were not carefully observed,or prolonged delayed scanning was not performed;(4)MRI scans and MRCP could show the tendrilGlike dilated intrahepatic bile duct,the filling defect of the bile duct wall with focally eccentric thickening,and stiffness of the bile duct;(5)Elder patients,long course of disease,recurrent attacks and increased CA19G9/CEA level could be factors related to IHHCC.Conclusion The early stage of hepatolithiasis combined with cholangiocarcinoma is easy to be misdiagnosed for cholelithiasis and cholangitis.DelayGenhanced CT,MRI scanning and MRCP are helpful to improve preoperative diagnostic rate for the patients with elder age,longer course of disease,repeated onset,increased CA1 9G9/CEA level and inconsistent degree of peripheral biliary dilatation with the size and location of the calculi.