胆管炎与肝外胆管癌的多层螺旋CT诊断

MSCT Diagnosis of Cholangitis and Extrapepatic Biliary Duct Carcinoma

目的:评价多层螺旋CT(Multi-slice computed tomography,MSCT)诊断胆管炎和肝外胆管癌的价值。材料和方法:对30例表现为梗阻性黄疸患者,经临床随访、ERCP和手术病理证实为胆管炎(10例)和胆管癌(20例)。MSCT检查上腹部,观察常规和薄层三维重建(MPR、MIP、CPR)图像,判断有无胆管扩张、胆管内或肝门区肿块、胆管壁局限增厚、肝脏有无直接侵犯征象,做出胆管炎或胆管癌诊断。结果:MSCT诊断胆管炎和肝外胆管癌的平均符合率为89.9%。胆管壁局限增厚对鉴别胆管炎和胆管癌具有重要意义。胆管内或肝门区肿块、肝脏直接侵犯征象诊断胆管癌的灵敏度为100%,阳性预测值分别为20%和25%。结论:MSCT结合薄层三维重建可较准确诊断胆管炎和肝外胆管癌。胆管壁局限增厚是肝外胆管癌的较特征性CT征象。

Purpose： To evaluate the MSCT accuracy in the diagnosis of cholangitis and extrahepatic biliary duct carcinoma. Materials and Methods： Thirty patients presenting with jaundice were examined with MSCT with iv. Contrast administration. The diagnosis of cholangitis（ n = 10） and extrahepatic biliary duct carcinoma（ n =20） was confirmed by following-up, ERCP and surgery. On CT axial and 3-D images （MPR, MIP, CPR）, the biliary duct dilation, mass on biliary duct wall or hepatic hilar area, bile duct wall thickening, liver invading of tumors were evaluated and the diagnosis of cholangitis or extrahepatic biliary duct carcinoma were made by three doctors unaware clinical data. Results： The average accuracy of MSCT for all 30 patients with cholangitis and extrahepatic biliary duct carcinoma was 89.9%. The biliary duct wall thinking was of important role in differentiation to the extrahepatic biliary duct carcinoma from cholangitis. The sensitivity of mass on or in biliary duct or hepatic hilar area and liver invading of tumors was 100% but the positive predictive value were 20% and 25%, respectively. Conclusion： The MSCT with 3D images has a high accuracy on identify the cholangitis and extrahepatic biliary duct carcinoma. The biliary duct wall thickening is a specific finding to the identification of extrahepatic biliary duct carcinoma.