16层螺旋CT曲面重建在诊断胆总管扩张疾病中的应用

Application of 16-slice spiral CT with curved planar reconstruction in diagnosing choledochectasia

目的评价16层螺旋CT曲面重建对诊断胆总管扩张病变的应用价值。方法 51例经手术及其中43例又经病理证实的胆总管扩张患者,包括34例恶性病变(14例胆总管癌,11例胰腺癌,9例肝癌或肝转移瘤)和17例良性病变(8例胆总管结石,4例胆总管炎性狭窄,3例胆囊切除术后,2例胰腺炎)均经16层螺旋CT腹部平扫,随后将源像传送至工作站进行后处理曲面重建(CPR)。结果 CPR能直接全程显示扩张的胆总管,准确判断其梗阻部位、范围、形态以及与邻近解剖结构的关系,并能鉴别良恶性病变的CT征象,例如,胆总管癌表现为胆总管中段管腔内结节影和肝内、外胆管重度扩张,而胰腺炎合并胆总管结石表现为胆总管与胆囊扩张,横轴位像显示胆总管胰头处结节状结石影。结论 CPR在诊断胆总管扩张及鉴别其良恶性病变中起重要作用,它应作为诊断本病的首选方案。

Objective To evaluate the usefulness of 16-slice spiral CT with curved planar reconstruction（CPR） in diagnosing the choledochectasia.Methods Fifty-one patients with surgically and pathologically（43 of them） proved choledochectasia which comprised 34 cases of malignant lesions（14 common bile duct carcinomas,11 pancreatic carcinomas,9 hepatic carcinomas or metastases） and 17 cases of benign lesions（8 choledocholithiasis,4 inflammatory common bile duct strictures,3 post-cholecystectomy,2 pancreatitis） underwent conventional CT scans of the abdomen and dual phasic contrast-enhanced CT scans.The source images were transferred into the workstation and postprocessed by CPR.Results CPR could directly and fully show the dilated common bile ducts,accurately identify the location,extent and shape of choledochectasia and its relationship with neighbour anatomy structures,and could differentiate CT signs between benign and malignant lesions,for example,common bile duct carcinomas appeared as intraluminal stone shadows in middle segments of common bile ducts associated with severe dilatation of intrahepatic and extrahepatic bile ducts,while pancreatitis complicated with choledocholithiasis appeared as dilatation of common bile ducts and gallbladders,simultaneously,the axial images showed nodular stone shadows in the pancreatic-head site of common bite ducts.Conclusion CPR plays important role in diagnosing choledochectasia and differentiating CT signs between benign and malignant lesions so that it shoud be taken as first protocol to diagnose this disease.