肝内外胆管癌的螺旋CT诊断

Spiral CT in diagnosis of intrahepatic and extrahepatic cholangiocarcinoma

目的:探讨肝内外胆管癌的螺旋CT表现及鉴别诊断。方法:收集23例经手术、病理证实的肝内外胆管癌,回顾性分析其螺旋CT平扫及动态增强表现。结果:肝内胆管癌5例,CT平扫为边缘欠清的低密度病灶中可有高密度钙化影,增强扫描随时间延长病灶由边缘向中央逐步强化,最后病灶强化高于正常肝实质,病灶周围可见扩张的肝内胆管。肝门胆管癌6例,CT表现为肝内胆管扩张,胆总管或左右肝管起始部狭窄、充盈缺损、轻中度强化的肝门软组织肿块。中下段胆管癌12例,CT表现为肝内胆管扩张、病变以上胆总管扩张、病变处胆总管狭窄、中断,梗阻近端胆管壁不均匀增厚、腔内见软组织结节影或周围软组织肿块。结论:肝内胆管癌及肝门部胆管癌根据CT动态增强表现不难作出诊断,胆总管癌须认真分析CT薄层放大增强表现鉴别其他低位梗阻性胆道疾病后作出诊断。

Objective： To investigate spirl CT findings and differential diagnosis of intrahepatie and outhepatie cholangiocarcinoma. Methods： Spid CT findings and dynamic enhanced CT findings of 23 cases of intrahepafie and outhepatie eholansiocareinoma proved surgically and pathologically were analyzed retrospectively. Results：5 cases were intrahepatie cholangiocareinoma, low density lesion with spot like calcification and ill-defined margin on plain, in delayed scan there was progressive enhancement from periphery to center, but some of lesions had no or mild enhancement in the center, at last the density of the lesion was higher than that of normal liver, cholangiectasis around the lesion. 6 cases were hilar cholangiocarcinoma, the CT findings included intrahepatic biliary dilatation, narrowing or filting defect of left or right duct or common hepatc duct, and soft tissue mass at hilum of liver. 12 eases were extrahepatic cholangiocareinoma, the CT findings appeared as dilatation of intahepatie bile duct and the segment of CBE above the lesion, and narrowing, interruption of the sngment of the segment of CBD invaded by the tumor, it can be shown the unevenly thickened wall in proximal end of the obstruction, intraductal soft tissue node or soft tissue mass around CBD. Conclusion：It is no difficult to make a diagnosis of intrahepatie and hilar cholangiocarcinoma based on the features of dynamic multiphasie spiral CT scan, but CBD carcinoma should be analyse the expressions of enhaned CT scanning with thin section and magnification, it also should be differentiated from other obstructive disease at lower segment of CBD.