64层螺旋CT三维成像在消化系统疾病诊治中的临床应用价值

The value of three-dimensional 64-multi-slices helical computer tomography on the diagnosis of diseases of digestive system

目的研究64层螺旋 CT 三维成像在肝胆胰等消化系统疾病诊断及外科治疗方面的应用价值。方法对2005年11月至2006年8月的102例肝胆胰疾病患者行64层螺旋 CT 扫描及后期三维成像,立体、多角度观察病灶、肝脏管道、胰胆管结构及门静脉系统的影像学特征,结合临床手术进行对比分析。结果 27例门静脉高压症患者中,25例门静脉主干清晰成像,2例门静脉主干显影不全,分别为门静脉海绵样变性和门静脉主干血栓形成。27例侧支循环显示良好。34例原发性肝癌患者中,肿瘤压迫邻近血管者9例,门静脉癌栓1例,动静脉瘘1例,23例未见肿瘤侵犯邻近组织、血管。肝内外胆管结石25例,胆管癌5例,胰腺癌5例,胆道三维成像可多方位显示结石和肿瘤,以及梗阻远、近端狭窄及扩张的胆道和胰管。根据影像资料制定手术方案,门静脉高压症、原发性肝癌、胆胰疾病的手术探查与影像学诊断符合率分别为100%、97%和100%。结论 64层螺旋 CT 三维成像能够清晰立体的显示病灶形态、肝脏管道及胰胆管结构,精确判断病灶与周围组织的关系。

Objective To study the value of three-dimensional 64-slice helical computer tomography （64-MSCT） in diagnosis and surgical treatment on diseases of digestive system. Methods From November 2005 to August 2006, 64-MSCT was performed on 102 patients suspected of digestive diseases to display loci of infection, hepatic conduit, biliary-pancreatic duct and portal venous system, followed by three-dimensional reconstruction of those targets. The reconstructed images as well as the data obtained from the reconstruction were compared with the surgical results. Results Twenty-five of 27 patients with portal hypertension （PHT） showed blur-free imaging of main portal vein（MPV） while the other 2 cases showed congenital cavernous transformation or thrombogenesis of MPV. Compensatory circulation of portal venous system was displayed satisfactorily in 27 cases. The three-dimensionally reconstructed images of 34 cases of hepatocellular carcinoma （HCC） demonstrated no invasion of tumors into the tissues and blood vessels of 23 cases, visible invasion into portal vein and hepatic veins of 9 cases, tumor embolus in portal veins of I case, and arterio-venous fistula in only one case. The 3D imaging of biliary passages displayed total concretion, tumor and constrictive or dilated biliary-pancreatic duct and bile duct around amphiobstruction, which complied with the operations research of calculus of bile duct in 25 cases, cholangiocarcinoma in 5 cases, and cancer of pancreas in 5 cases. Operations research in accordance with the 3D reconstructed imaging accorded with imageological diagnosis in respect of PHT, HCC and diseases of biliary-pancreatic system at the rates of 100%, 97% and 100%, respectively. Conclusions Three- dimensional 64-MSCT displays loci of infection and constructions of biliary-pancreatic duct and hepatic conduit stereoscopically.