肝门胆管癌术前多层螺旋CT诊断价值

Multislice CT in preoperative evaluation of resectability of hepatic hilar cholangiocarcinoma

目的回顾性分析肝门胆管癌多层螺旋CT表现与手术结果,评价肝门胆管癌多层螺旋CT扫描术前诊断价值。方法收集本院2004年3月～2010年7月间CT术前扫描、手术病理证实的肝门胆管癌66例,由3名主治以上医师联合读片诊断。以下情况认为肿瘤不可切除:对侧肝动脉侵犯、门静脉主干或对侧门静脉支侵犯、腹腔及膜膜后淋巴结肿大。由3名主治医师以上放射专家集体读片得出诊断结论。结果与术后结果对比,CT诊断门静脉侵犯准确性达80.8%(21/26),CT显示肝动脉侵犯准确性约90.5%(19/21),淋巴结肿大显示准确性约93.8%(15/16),沿管壁侵犯显示准确性约82.0%,CT认为可切除肿瘤47例中,手术中36例(76.6%)成功切除,19例CT提示不能切除,术中17例(89.5%)不能切除。结论术前CT对肝门胆管癌可切除性判断总的准确性约80.3%。

Objective To retrospectively assess the accuracy of multislice CT for evaluation of the resectability of hilar cholangiocarcinoma,by using surgery as the reference standard.Methods We collected cases of hilar cholangiocarcinoma from March 2004 to July 2010,66 patients with surgically proved hilar cholangiocarcinomas and preoperative CT were included for study.The criteria for unresectable tumor were contralateral hepatic artery invasion;main or contralateral portal vein invasion;enlarged lymph nodes at the peritoneal cavity and retroperitoneum.Tumor resectability based on these parameters was determined at imaging by three radiologists in consensus of agreement.Results For depiction of portal vein invasion （21/26）,CT accuracy is 80.8%.Arterial invasion was found at surgery in 21 patients,with CT providing an accuracy of 90.5%（19/21）.For prediction of node enlargement,CT accuracy is about 93.8%（15/16）.The extent of ductal involvement could be accurately predicted in 40 fo 46 patients（82%）.Among the 47 cases which was predicted to be rectable,36 cases were rected,the accuracy is 76.6%.In 17 of 19 patients with disease classified as unresectable according to the criteria,unresectable disease was confirmed to be unrectable（89.5%）.Overall accuracy of resectability was 80.3%.Conclusion By using our criteria,preoperative CT resulted in overall accuracy of 80.3% for prediction of respectability for hilar cholangiocarcinoma.