多层螺旋CT最小密度投影联合曲面重组胆道成像对肝门部胆管癌的应用价值

Application of Multi-slice Spiral CT Minimum Intensity Projection Imaging Combined with Biliary Curved Planar Reconstruction for Hilar Cholangiocarcinoma

目的探讨多层螺旋CT(MSCT)的左前斜冠位最小密度投影(MinIP)联合曲面重组(CPR)胆道成像在肝门部胆管癌诊断及分型中的应用价值。资料与方法21例拟诊为肝门部胆管癌患者,行胆管左前斜冠位MinIP+CPR,对肝门部周围结构和胆管壁的显示效果及定性、分型符合率进行评价。结果 18例显示肝门区不规则形或类圆形软组织密度肿块,多呈缓慢延迟强化;3例仅表现为胆管壁不规则增厚,偏心性狭窄或闭塞,肝内胆管呈梗阻性扩张。21例中,3例肝左叶萎缩,4例邻近肝实质受侵犯,形成软组织肿块,6例合并胆道系统结石。对照手术病理结果,MSCT胆道成像定性符合率为100.0%,分型符合率为95.2%,准确率高于常规轴位图像。结论 MSCT左前斜冠位MinIP+CPR胆道成像对肝门部胆管癌的诊断及分型具有重要价值。

Purpose To explore the application value of multi-slice spiral CT （MSCT） left anterior oblique coronal minimum intensity projection （MinlP） combined with biliary curved planar reformation （CPR） for the diagnosis and classification of hilar cholangiocarcinoma. Materials and Methods 21 patients suspected as hilar cholangiocarcinoma underwent bile duct left anterior oblique coronal MinlP and CPR, display effect of hilar surrounding structures and bile duct wall, qualitative and classification compliance rate were evaluated. Results 18 cases showed irregular or oval soft tissue density mass in hilar region, most with slow delayed enhancement; 3 cases showed only irregular bile duct wall thickening, eccentric stenosis or occlusion and obstructive intrabepatic bile duct dilatation： among the 21 cases, 3 cases showed leR hepatic lobe atrophy, 4 cases showed fbrmation of soft tissue masses due to violations of the adjacent liver parenchyma, and 6 cases combined with biliary stones. Qualitative and classification compliance rate of MSCT biliary imaging was 100% and 95.2%, respectively taking operation pathology results as reference standard, with higher accuracy than conventional axial images. Conclusion MSCT left anterior oblique coronal imaging MinlP and CPR biliary imaging is significantly valuable tbr the diagnosis and classification of hilar cholangiocarcinoma.