胆囊癌多层螺旋CT分期和手术可切除性评价

16-slice spiral CT in staging and assessing respectability of gallbladder carcinoma

目的评价16层螺旋CT三期增强后三维重建在确定胆囊癌的CT分期和评价手术可切除性的价值。方法27例临床和超声检查怀疑胆囊癌的病例,前膽性分析其16层螺旋CT三期增强表现,其中20例做了胆囊癌根治性切除术或姑息手术的患者。三维容积重建评价血管的解剖及受侵犯情况,CT分期及可切除性评价与手术结果对照。结果根据CT表现,8例肿瘤可切除,12例不能切除。术中发现11例肿瘤可切除,9例不能切除,3例CT分期过高,认为不能切除的病例是由于CT误诊十二指肠受浸润。在评价胆囊癌可切除性方面,CT的敏感性为72.7%(8/11),特异性为100%,准确性为85%(17/20),在肝脏和血管受侵犯方面和CT评价和手术所见完全一致,接受根治性胆囊癌切除的患者中发现6例血管变异。结论三期增强螺旋CT三维重建是一种可靠的分期胆囊癌的影像方法,术前可确定血管的走行路径。

Objective The purpose of our study was to determine the utility of three-phase 16-slice spiral CT with 3D reconstruction in the staging and respectability of gallbladder carcinoma. Methods 27 consecutive patients with suspected gallbladder carcinoma on clinical examination and routine sonography were prospectively analyzed with three-phase 16-slice spiral CT of these patients, only 20 who underwent a laparotomy for extended sholeeystectomy or a palliative surgery were included in the study. Three-dimensional volume-rendered reconstruction was used for evaluation of the vascular invasion and anatomy. The staging and respectability as determined on CT were compared with preoperative findings. Results On the basis of the CT findings, eight tumors were respectable and 12 were untable. Overstaging by CT occurred in three patients due to overassessment of duodenal infiltration. CT had a sensitivity of 72. 7%, a specificity of 100%, and an accuracy of 85% for determining respectability of gallbladder carcinoma. For the diagnosis of hepatic and vascular invasion by the tumor, there was 100% correlation between CT and surgery. Vascular variations were found in six of the 11 patients who underwent radical cholecystectomy. Conclusion Three-phase 16-slice spiral CT with 3D reconstruction is a comprehensive imaging technique for staging gallbladder carcinoma and determining the vascular road map before surgery.