Imaging Study Of Cholangiocarcinomas Associated With Clonorchiasis

Objective To compare the imaging features of CT and MRI in patients with clonorchiasis associated cholangiocarcinoma and cholangiocarcinoma without clonorchiasis.Contrast pathological analysis of tumor types and peripheral bile duct dilatation in clonorchiasis associated cholangiocarcinoma.To improve the understanding of the imaging of MRI and CT in cholangiocarcinomas associated with clonorchiasis; and to explore the relationship between the clonorchiasis and cholangiocarcinoma.Methods CT and MRI data of 60 patients with cholangiocarcinomas proved by surgery or biopsy were retrospectively analyzed.53 cases underwent CT plain scan and enhancement,48 cases underwent MRI examinations(including 22 cases underwent MRCP) including clonorchiasis with cholangiocarcinomas in 26(group A), cholangiocarcinomas withnot clonorchiasis in (group B). MRI (including 12 cases of MRCP) images of 19 cases of A group were analyzed, and the tumor types and bile duct dilatation were compared with pathological results.Results 1、(1) In group A,13 cases were belong to central type of bile duct carcinoma. Among them,4 cases were located in left hepatic duct,4 cases were in right hepatic duct, and 5 cases were in common hepatic duct; In 13 cases of peripheral cholangiocarcinoma,12 cases were located in the right liver lobe; 1 case was in the left hepatic lobe. In group B of central cholangiocarcinoma,10 cases were located in left hepatic duct,2 cases were in right hepatic duct, and 11 cases were in common hepatic duct. In 11 cases of peripheral cholangiocarcinoma,6 cases were located in the left hepatic lobe and 5 cases were in the right liver lobe. The distribution of two group lesions was statistically significant difference (P< 0.05). (2) The tumor pathological types:In group A,19 cases were nodule type/mass (73.1%),4 cases were infiltrating type (15.4%),3 patients were cavity growth form (11.5%). In group B,18 cases were lump (52.9%),8 cases were infiltrating type (23.5%),8 cases were cavity growth form (23.5%). The difference of the pathological type in two groups were no statistical significance (P> 0.05), but in nodular/mass type, the proportion of A group was obviously higher than that of group B.(3) In CT and MRI scan, the density、signal characteristics and enhancement pattern were no statistically significant difference (P 0.05) in two groups. (4) the characteristics of bile duct expansion:In group A,16 cases (61.5%) were observed bile duct expansion which presented utricle or twigs shape under the liver capsule,5 cases (19.2%) were soft rattan shaped expansion, the dilated bile ducts were occurred in tumor surrounding in13 cases (50%), and within tumor in 2 cases (7.7%). In group B, soft rattan shaped expansion were observed in 22 cases (64.7%), diffuse utricle or drumstick expansion were seen in 2 cases (5.9%), and bile duct expansion located intra-tumor in 13 (38.2%). Around the tumor visible dilatation of bile duct in 7 cases (20.6%)。The difference between the shape of intrahepatic distal bile ducts expansion and the location of bile duct dilation (intra or extra tumor) were statistically significant (P< 0.05) in two groups.2、(1)In the A group,19 cases of cholangiocarcinoma MRI showed that the poorly differentiated adenocarcinoma accounted for 47.4%, and the high differentiation adenocarcinoma accounted for 42.1%, and the highly differentiated papillary tumors accounted for 10.5%. (2)In the common MRI examination,13 cases (68.4%) showed the expansion of the distal bile duct. MRCP showed 10 cases (83.3%) of the bile duct dilation. The pathologic specimen showed that the distal bile duct was dilated to 100%.Conclusion Expression of cholangiocarcinomas associated with clonorchiasis imaging has certain characteristics. There was no significant difference in the pathological types, the density, signal characteristics and enhancement patterns between the two groups. On the other hand, there was different in the pattern of intra hepatic bile ducts dilation caused by the two groups of cholangiocarcinomas. MRI can better reflect the pathological type of the tumor of cholangiocarcinomas; MRCP can be more easily found in the peripheral bile duct of cholangiocarcinomas associated with clonorchiasis than the MRI common examination.Clonorchiasis disease may be associated with cholangiocarcinoma, long-term clonorchiasis fluke infection may be a risk factor for the happening of cholangiocarcinoma.