多层螺旋CT多期扫描对肝门部胆管癌的诊断与术前评估

Value of Spiral CT in diagnosis of hilar cholangiocarcinoma

目的探讨肝门部胆管癌的螺旋CT表现,评价多层螺旋CT多期扫描的诊断价值及对手术可切除性的指导意义。方法对26例经手术和病理证实的肝门部胆管癌的多层螺旋CT平扫及多期增强扫描资料,观察肿块的部位、大小、强化的特征和累及的范围,并与手术结果对照。结果26例肝门部胆管癌均可见肝门肿块、肝内胆管扩张、肝门部胆管中断,动态增强扫描有12例表现为动脉期强化,15例门脉期强化,26例延时期强化。CT分型与手术分型对比,诊断准确度为76.9%(Kappa>0.4);可切除性评估的敏感度66.7%,特异度78.2%,诊断准确度76.9%。结论多层螺旋CT多期增强扫描可清晰显示病灶的部位、强化特征和范围,对肝门部胆管癌的诊断和鉴别诊断有重要价值,有助于术前治疗方案的选择和可切除性的评估。

Objective To describe CT features and assess the diagnosis value of dynamic multiphasie spiral CT in evaluating hilar eholangiocareinorna and assesmnent of tumor reseetability. Methods 26 patients with pathologically proven hilarl eholangiocareinoma were per- formed unenhanced and multi - phase dynamic contrast enhanced CT scanning, The location, size, enhancement patterns of the lesions and the extent of the tumnor involvement were observed and compared with surgical result. Results Hilar masses, dilatation of intrahepatic ducts and discontinuity of hilar biliary ducts were seen in all cases. On dynamic enhanced scans, 12 lesions enhanced on the arterial phase, 15 lesions enhanced on the portal venous and 26 prolonged enhancement were seen in the delayed scanning phase. Compared with classification of CT and classification of operation , the diagnostic accuracy rates of CT was 76.9 % （Kappa 〉 0.4 ）. Sensitivity and specificity was 66.7 %, 78.2 %, 76.9 % for the assesment of tumor resectability by CT. Conclusion Multi - phase contrast enhanced CT scanning can obviously deminstrate the location, enhanced patterns and the extent of hepatic portal cholangiocarcinorna. Multi-phase contrast enhanced CT scanning is of great value to diagnosis and differential diagnosis of hilar cholangiocarcinoma, and it is helpful in choosing the preoperative treatment program and assessment of tumor resectability.