超声对肝内胆管癌微血管侵犯的评估价值与技术进展

卫星彤; 李昊昌; 赵欣

doi:10.12449/JCH260535

超声对肝内胆管癌微血管侵犯的评估价值与技术进展

DOI: 10.12449/JCH260535

内蒙古医科大学附属医院超声科，呼和浩特 010050

基金项目:

内蒙古医科大学面上项目 (YKD2025MS006)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：卫星彤负责选题，收集分析资料，撰写文章；赵欣参与选题，收集资料；李昊昌指导撰写文章，提供修改意见并最终定稿。

详细信息

通信作者:
李昊昌， haochangli0606@sina.com （ORCID： 0009-0009-1197-4912）

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出版历程
- 收稿日期: 2025-08-17
- 录用日期: 2025-11-03
- 出版日期: 2026-05-20

Value of ultrasound in assessing microvascular invasion of intrahepatic cholangiocarcinoma and related technical advances

Department of Ultrasound，The Affiliated Hospital of Inner Mongolia Medical University，Hohhot 010050，China

Research funding:

Inner Mongolia Medical University General Project (YKD2025MS006)

More Information

Corresponding author: LI Haochang， haochangli0606@sina.com （ORCID： 0009-0009-1197-4912）

摘要

摘要: 术前无创评估肝内胆管癌（ICC）微血管侵犯（MVI），对制定个体化治疗方案及判断预后至关重要。本综述旨在全面探讨超声技术在此领域的应用价值，详细阐述了灰阶超声、超声造影和超声弹性成像等技术通过分析病灶形态、血流灌注及硬度特征对MVI的预测效能；同时，对影像组学、深度学习及动态三维超声造影等新兴技术的应用前景进行了展望。综合分析表明，超声在评估ICC MVI方面已展现出重要临床价值；进一步将新兴技术融入超声评估体系，有望实现更客观、更精准的术前预测，具有广阔的应用前景。
- 胆管上皮癌 /
- 超声检查 /
- 微血管侵犯
Abstract: Noninvasive preoperative assessment of microvascular invasion （MVI） of intrahepatic cholangiocarcinoma （ICC） is crucial for developing individualized treatment regimens and judging the prognosis of patients. This article comprehensively explores the application value of ultrasound in this field and elaborates on the performance of techniques such as gray-scale ultrasound， contrast-enhanced ultrasound， and ultrasound elastography in predicting MVI by analyzing lesion morphology， blood perfusion， and stiffness characteristics， and meanwhile， it also discusses the application prospects of emerging techniques such as radiomics， deep learning， and dynamic three-dimensional contrast-enhanced ultrasound. The comprehensive analysis shows that ultrasound has an important clinical value in assessing ICC MVI， and the integration of emerging techniques into the ultrasound evaluation system can help to achieve more objective and accurate preoperative prediction and thus has broad application prospects.
- Cholangiocarcinoma /
- Ultrasonography /
- Microvascular Invasion

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参考文献(37)

[1]	National Health Commission of the People’s Republic of China. Standard for diagnosis and treatment of primary liver cancer(2024 edition)[J]. J Clin Hepatol, 2024, 40( 5): 893- 918. DOI: 10.12449/JCH240508. 中华人民共和国国家卫生健康委员会. 原发性肝癌诊疗指南(2024年版)[J]. 临床肝胆病杂志, 2024, 40( 5): 893- 918. DOI: 10.12449/JCH240508.
[2]	TJADEN C, HINZ U, KLAIBER U, et al. Distal bile duct cancer: Radical(R0> 1 mm) resection achieves favorable survival[J]. Ann Surg, 2023, 277( 1): e112- e118. DOI: 10.1097/SLA.0000000000005012.
[3]	DING ZW, ZHAO YM, WANG L. Progress in surgical and systematic treatment of intrahepatic cholangiocarcinoma[J/OL]. Chin J Hepat Surg(Electronic Edition), 2025, 14( 2): 187- 196. DOI: 10.3877/cma.j.issn.2095-3232.2025033. 丁志文, 赵一鸣, 王鲁. 肝内胆管癌手术与综合治疗[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14( 2): 187- 196. DOI: 10.3877/cma.j.issn.2095-3232.2025033.
[4]	CHOI WJ, WILLIAMS PJ, CLAASEN MPAW, et al. Systematic review and meta-analysis of prognostic factors for early recurrence in intrahepatic cholangiocarcinoma after curative-intent resection[J]. Ann Surg Oncol, 2022, 29: 4337- 4353. DOI: 10.1245/s10434-022-11463-x.
[5]	GOUW ASH, BALABAUD C, KUSANO H, et al. Markers for microvascular invasion in hepatocellular carcinoma: Where do we stand[J]. Liver Transpl, 2011, 17( Suppl 2): S72- S80. DOI: 10.1002/lt.22368.
[6]	ZHANG XP, WANG K, WEI XB, et al. An eastern hepatobiliary surgery hospital microvascular invasion scoring system in predicting prognosis of patients with hepatocellular carcinoma and microvascular invasion after R0 liver resection: A large-scale, multicenter study[J]. Oncologist, 2019, 24( 12): e1476- e1488. DOI: 10.1634/theoncologist.2018-0868.
[7]	OLIVEIRA IS, KILCOYNE A, EVERETT JM, et al. Cholangiocarcinoma: Classification, diagnosis, staging, imaging features, and management[J]. Abdom Radiol(NY), 2017, 42( 6): 1637- 1649. DOI: 10.1007/s00261-017-1094-7.
[8]	SPOLVERATO G, EJAZ A, KIM Y, et al. Tumor size predicts vascular invasion and histologic grade among patients undergoing resection of intrahepatic cholangiocarcinoma[J]. J Gastrointest Surg, 2014, 18( 7): 1284- 1291. DOI: 10.1007/s11605-014-2533-1.
[9]	ZHOU Y, WANG XL, XU C, et al. Mass-forming intrahepatic cholangiocarcinoma: Can diffusion-weighted imaging predict microvascular invasion[J]. J Magn Reson Imaging, 2019, 50( 1): 315- 324. DOI: 10.1002/jmri.26566.
[10]	CHEN S, WAN LJ, ZHAO R, et al. Nomogram based on preoperative clinical and MRI features to estimate the microvascular invasion status and the prognosis of solitary intrahepatic mass-forming cholangiocarcinoma[J]. Abdom Radiol(NY), 2024, 49( 2): 425- 436. DOI: 10.1007/s00261-023-04079-6.
[11]	GUO JY, WANG MB, XUE SY, et al. Establishment a nomogram model for preoperative prediction of the risk of cholangiocarcinoma with microvascular invasion[J]. Eur J Surg Oncol, 2025, 51( 1): 109361. DOI: 10.1016/j.ejso.2024.109361.
[12]	CAI CP, WANG XJ, FU QR, et al. The VEGF expression associated with prognosis in patients with intrahepatic cholangiocarcinoma: A systematic review and meta-analysis[J]. World J Surg Oncol, 2022, 20( 1): 40. DOI: 10.1186/s12957-022-02511-7.
[13]	YUAN MX, LI R, ZHANG YJ, et al. Enhancement patterns of intrahepatic cholangiocarcinoma on contrast-enhanced ultrasound: Correlation with clinicopathologic findings and prognosis[J]. Ultrasound Med Biol, 2019, 45( 1): 26- 34. DOI: 10.1016/j.ultrasmedbio.2018.08.014.
[14]	JANG HJ, KIM DH, CHOI SH, et al. Preoperative prediction of microvascular invasion in intrahepatic cholangiocarcinoma and its prognostic implications: A multicenter study[J]. Liver Cancer, 2025. DOI: 10.1159/000547071.[ Epub ahead of print]
[15]	MA XJ, LIU LH, FANG J, et al. MRI features predict microvascular invasion in intrahepatic cholangiocarcinoma[J]. Cancer Imaging, 2020, 20( 1): 40. DOI: 10.1186/s40644-020-00318-x.
[16]	SALEH M, VIRARKAR M, BURA V, et al. Intrahepatic cholangiocarcinoma: Pathogenesis, current staging, and radiological findings[J]. Abdom Radiol(NY), 2020, 45( 11): 3662- 3680. DOI: 10.1007/s00261-020-02559-7.
[17]	GUO HL, ZHENG X, CHENG MQ, et al. Contrast-enhanced ultrasound for differentiation between poorly differentiated hepatocellular carcinoma and intrahepatic cholangiocarcinoma[J]. J Ultrasound Med, 2022, 41( 5): 1213- 1225. DOI: 10.1002/jum.15812.
[18]	AINORA ME, CERRITO L, LIGUORI A, et al. Multiparametric dynamic ultrasound approach for differential diagnosis of primary liver tumors[J]. Int J Mol Sci, 2023, 24( 10): 8548. DOI: 10.3390/ijms24108548.
[19]	WANG XH, LIANG P, YU J, et al. Contrast-enhanced ultrasound features predict the prognosis of percutaneous microwave ablation of intrahepatic cholangiocarcinoma[J]. Br J Radiol, 2022, 95( 1133): 20211379. DOI: 10.1259/bjr.20211379.
[20]	SIRICA AE, GORES GJ. Desmoplastic stroma and cholangiocarcinoma: Clinical implications and therapeutic targeting[J]. Hepatology, 2014, 59( 6): 2397- 2402. DOI: 10.1002/hep.26762.
[21]	ALISON MR. Liver stem cells: Implications for hepatocarcinogenesis[J]. Stem Cell Rev, 2005, 1( 3): 253- 260. DOI: 10.1385/SCR: 1: 3: 253.
[22]	ZHU MR, ZHAO CK, SUN YK, et al. Subtype prediction of intrahepatic cholangiocarcinoma using dynamic contrast-enhanced ultrasound[J]. Insights Imaging, 2024, 15( 1): 119. DOI: 10.1186/s13244-024-01683-y.
[23]	AFFO S, YU LX, SCHWABE RF. The role of cancer-associated fibroblasts and fibrosis in liver cancer[J]. Annu Rev Pathol, 2017, 12: 153- 186. DOI: 10.1146/annurev-pathol-052016-100322.
[24]	PISCAGLIA F, SALVATORE V, MULAZZANI L, et al. Ultrasound shear wave elastography for liver disease. a critical appraisal of the many actors on the stage[J]. Ultraschall Med, 2016, 37( 1): 1- 5. DOI: 10.1055/s-0035-1567037.
[25]	CARPINO G, OVERI D, MELANDRO F, et al. Matrisome analysis of intrahepatic cholangiocarcinoma unveils a peculiar cancer-associated extracellular matrix structure[J]. Clin Proteomics, 2019, 16: 37. DOI: 10.1186/s12014-019-9257-x.
[26]	XU CC, JIANG D, TAN BB, et al. Preoperative diagnosis and prediction of microvascular invasion in hepatocellularcarcinoma by ultrasound elastography[J]. BMC Med Imaging, 2022, 22( 1): 88. DOI: 10.1186/s12880-022-00819-0.
[27]	TIAN QY, YU J, HUANG G. Pathogenesis of hepatitis B-associated intrahepatic cholangiocarcinoma[J]. J Clin Hepatol, 2024, 40( 4): 797- 803. DOI: 10.12449/JCH240425. 田奇玉, 余建, 黄罡. 乙型肝炎相关肝内胆管癌的发病机制[J]. 临床肝胆病杂志, 2024, 40( 4): 797- 803. DOI: 10.12449/JCH240425.
[28]	SHI ML, SHEN Y, WANG MD, et al. Interpretation of clinical practice guidelines of diagnosis and treatment of hepatobiliary tumors: hepatocellular carcinoma and intrahepatic cholangiocarcinoma[J]. Chin J Dig Surg, 2024, 23( 2): 188- 196. DOI: 10.3760/cma.j.cn115610-20231212-00251. 石明亮, 申洋, 王明达, 等. 肝胆肿瘤临床诊疗实践系列指南解读: 肝细胞癌和肝内胆管癌[J]. 中华消化外科杂志, 2024, 23( 2): 188- 196. DOI: 10.3760/cma.j.cn115610-20231212-00251.
[29]	MASSARWEH NN, EL-SERAG HB. Epidemiology of hepatocellular carcinoma and intrahepatic cholangiocarcinoma[J]. Cancer Control, 2017, 24( 3): 1073274817729245. DOI: 10.1177/1073274817729245.
[30]	ZHONG X, CHEN LL, LONG HY, et al. The"stiff rim" sign of hepatocellular carcinoma on shear wave elastography: Correlation with pathological features and potential prognostic value[J]. Abdom Radiol(NY), 2022, 47( 12): 4115- 4125. DOI: 10.1007/s00261-022-03628-9.
[31]	MA JM, SUN L, LI XM, et al. Research progress of radiomics inpredicting microvascular invasion of intrahepatic cholangicarcinoma[J]. Chin J Magn Reson Imag, 2024, 15( 12): 224- 227, 234. DOI: 10.12015/issn.1674-8034.2024.12.035. 马佳美, 孙柳, 李晓萌, 等. 影像组学预测肝内胆管癌微血管侵犯的研究进展[J]. 磁共振成像, 2024, 15( 12): 224- 227, 234. DOI: 10.12015/issn.1674-8034.2024.12.035.
[32]	XU L, CHEN ZA, ZHU D, et al. The application status of radiomics-based machine learning in intrahepatic cholangiocarcinoma: Systematic review and meta-analysis[J]. J Med Internet Res, 2025, 27: e69906. DOI: 10.2196/69906.
[33]	PENG YT, ZHOU CY, LIN P, et al. Preoperative ultrasound radiomics signatures for noninvasive evaluation of biological characteristics of intrahepatic cholangiocarcinoma[J]. Acad Radiol, 2020, 27( 6): 785- 797. DOI: 10.1016/j.acra.2019.07.029.
[34]	HU HT, WANG Z, HUANG XW, et al. Ultrasound-based radiomics score: A potential biomarker for the prediction of microvascular invasion in hepatocellular carcinoma[J]. Eur Radiol, 2019, 29( 6): 2890- 2901. DOI: 10.1007/s00330-018-5797-0.
[35]	MAO LJ, CAO JY, WANG WP, et al. Application of dynamic three-dimensional contrast-enhanced ultrasound in the diagnosis of focal liver lesions[J]. Fudan Univ J Med Sci, 2021, 48( 5): 598- 602. DOI: 10.3969/j.issn.1672-8467.2021.05.005. 毛丽娟, 曹佳颖, 王文平, 等. 动态三维超声造影在肝局灶性病变诊断中的应用[J]. 复旦学报(医学版), 2021, 48( 5): 598- 602. DOI: 10.3969/j.issn.1672-8467.2021.05.005.
[36]	SONG Y, CHENG JL, ZHANG RF. Contribution of 3-dimensional contrast-enhanced ultrasonography(CEUS) compared with 2-dimensional CEUS in the analysis of liver tumors[J]. J Ultrasound Med, 2018, 37( 5): 1117- 1128. DOI: 10.1002/jum.14458.
[37]	CAO JY, YU LY, LIN C, et al. Dynamic three-dimensional contrast-enhanced ultrasonography for local minimally invasive treatment assessment on a rabbit hepatic VX2 tumor model[J]. Chin J Ultrasound Med, 2019, 35( 11): 1034- 1037. 曹佳颖, 于凌云, 林冲, 等. 动态三维超声造影评估兔肝VX2肿瘤局部微创治疗效果的实验研究[J]. 中国超声医学杂志, 2019, 35( 11): 1034- 1037.