中文摘要：

目的探讨合并肝硬化的小肝内胆管细胞癌（ICC）的MRI强化特征和鉴别诊断。方法本前瞻性队列研究对象为2012年12月至2015年12月在第二军医大学附属东方肝胆外科医院接受外科手术治疗的56例合并肝硬化的小ICC患者。其中男40例，女16例；年龄29～74岁，中位年龄54岁。患者均签署知情同意书，符合医学伦理学规定。患者行肝脏动态增强MRI检查，静脉注射钆喷酸葡胺造影剂。增强MRI扫描包括肝动脉期、门静脉期和延迟期。采用kappa系数评估观察者间判读强化类型的一致性。强化类型与病灶直径相关性分析采用Fisher确切概率法。结果观察者对病灶强化类型的判读一致性评价为优异（κ=0.82）。52%（29/56）小ICC表现为渐进型强化，36%（20/56）为稳定型强化，5%（3/56）为快进快出型强化，7%（4/56）为快进+衰退型强化。直径<20mm病灶最常见的强化类型为稳定型强化，20～30mm病灶最常见为渐进型强化，小ICC的强化类型与病灶直径具有相关性（P=0.006）。结论合并肝硬化的小ICC强化类型主要为稳定型和渐进型，但少部分表现为快进快出的强化特征，此类型与小肝癌强化类似，为两者鉴别诊断的重点和难点。

英文摘要：

Objective To investigate the MRI enhancement features and differential diagnosis ofsmall intrahepatic cholangiocarcinoma(ICC)combined with liver cirrhosis.Methods A total of56patientswith small ICC combined with liver cirrhosis who underwent surgical treatment in the Eastern HepatobiliarySurgery Hospital Affiliated to the Second Military Medical University between December2012andDecember2015were enrolled in this prospective cohort study.Among them,40cases were male and16were female,age29-74years old with a median age of54years old.The informed consents of all patientswere obtained and the local ethical committee approval was received.All the patient underwent hepaticdynamic enhanced MRI examination and intravenous injection of Gd-DTPA contrast.The enhanced MRIimaging included hepatic arterial phase,portal vein phase and delayed phase.Inter-observer consistency ofdetermining enhancement types was assessed by kappa coefficient.Correlation between enhancement typeand lesion diameter was analyzed by Fisher's exact probability test.Results The inter-observer consistency of determing lesion enhancement types was excellent(κ=0.82).52%(29/56)of the patients with small ICCpresented as progressive enhancement pattern,36%(20/56)as stable pattern,5%(3/56)as fast-in and fast-outpattern and7%(4/56)as fast-in+recession pattern.The most common enhancement pattern for the lesionswith a diameter of less than20mm was stable pattern,and progressive pattern for the lesions with a diameterof20-30mm.The enhancement pattern of small ICC was correlated with the diameter of lesion(P=0.006).Conclusions Most common MRI enhancement pattern for the patients with small ICC combined withliver cirrhosis are stable and progressive pattern.But some presents as fast-in and fast-out pattern,and thispattern is similar to that of small hepatocellular carcinoma,which is the key and difficult point for differentialdiagnosis between them.