小儿先天性胆总管囊肿的螺旋CT诊断

CT diagnosis of congenital choledochocyst in childhood

目的评价螺旋CT诊断小儿先天性胆总管囊肿的能力。方法16例手术证实的胆总管囊肿患儿(3名男孩和13名女孩,年龄1个月至14岁,平均4.3岁)均经CT平扫与增强扫描。10例又经图像后处理。回顾性分析全部患者的CT资料,并按Todani法分型。结果按Todani分类法,本组Ⅰa型10例,Ⅳa型6例。Ⅰa型CT平扫表现为肝、肾、胰头之间边缘光整的圆形囊性密度影,增强后,呈薄壁环形均匀强化;Ⅳa型CT平扫表现为肝门区及肝内多发囊性低密度影,增强后,胆总管囊壁强化,扩张的肝内胆管不强化,仍呈现低密度影;图像后处理(MPR,SSD)更清晰地显示了扩张胆管的形态与范围,并利于囊肿分型。结论小儿先天性胆总管囊肿的CT表现有一定特征,螺旋CT可为诊断本病提供可靠信息。

Objective To assess the capability of spiral CT for diagnosing congenital choledoehocyst in childhood.Methods Sixteen pediatric patients （3 boys and 13 girls,aged one month to 14 years,mean age,4.3 years）with surgically proved congenital choledochocyst underwent spiral CT scans without and with contrast enhancement. 10 patients underwent additional imaging postprocessing. CT data of all patients were retrospectively analyzed and classified by Todani＇s method.Results According to Todani＇s classification,there were 10 cases of type Ⅰ a and 6 eases of type Ⅳa in the group.On CT plain scans,type Ia appeared as round shadows with cystic density and smooth border between liver,kidney and pancreatic head.While on enhanced CT images,it appeared as thin wall and homogeneous-circular enhancement;type Ⅳ a appeared as multiple cystic shadows with hypodense on CT plain scans and following enhanced scans.the walls of choledochocyst were enhanced but intrahepatic delated bile duets were not enhanced and were still hypodense shadows.Imaging postprocessing such as MPR and SSD more clearly showed the shape and extent of the dilated bile duets and it could to help the typing of choledochocyst.Conchision CT findings of congenital choledocchoeyst have certain feature so that spiral CT can provide the reliable information to diagnose this disease.