CT检查在肝门部胆管癌诊断与可切除性评估中的价值

Value of computed tomography in the diagnosis and resectability evaluation of hilar cholangiocarcinoma

CT检查已成为肝门部胆管癌术前检查的一种重要的手段.本研究回顾性分析2010年9月至2012年9月上海交通大学医学院附属瑞金医院收治的20例经手术和活组织病理检查证实的肝门部胆管癌的多排螺旋CT表现,探讨多排螺旋CT检查在肝门部胆管癌诊断与可切除性评估中的价值.所有患者在腹部平扫后行动态增强扫描,包括动脉期和门静脉期,6例行3 ～4 min的延迟期扫描.扫描结束后进行二维和三维重建.观察肿瘤的部位、大小、邻近血管受累的范围、肝门部及腹膜后有无淋巴结的肿大、肝脏有无转移癌.CT平扫仅发现8个肿瘤,表现为肝门部低密度结节样肿瘤.增强扫描所有肿瘤可显示.5例浸润型表现为肝门部胆管壁局限性增厚,动脉期即可出现环形强化,门静脉期和延迟期的强化则更为明显.8例管内生长型表现为胆管内乳头状或结节状的软组织影,延迟强化的特征非常明显,肝内胆管扩张也非常明显.7例包块型表现为肝门部肿瘤,可累及邻近血管和部分肝组织.所有患者显示弥漫性或局灶性的肝内胆管扩张.二维和三维重建结合可以更加清晰地显示肿瘤以及肝动脉或门静脉受累、肝叶萎缩、淋巴结和肝脏转移的情况.多排螺旋CT横断面多期动态增强＋多平面重组＋ CT血管成像的“一站式”检查,可以更好地显示肝门部胆管癌肿瘤,进行术前准确分期,有助于外科精准化治疗方案的制订.

Computed tomography （CT） has become a very important method for preoperative examination for hilar cholangiocarcinoma. In this article, the muhideteetor helical CT findings of 20 patients with hilar cholangiocarcinoma who were confirmed by surgical pathological examination or biopsy in the Ruijin Hospital of Shanghai Jiaotong University from September 2010 to September 2012 were retrospectively analyzed to investi-gate the value of muhidetector helical CT in the diagnosis and resectability evaluation of hilar cholangiocarcinoma. All the 20 patients received dynamic contrast enhanced CT scanning after abdominal plain scanning, including arterial phase and portal venous phase scanning. Six patients received additional delayed phase scanning for 3-4 minutes. Multi-phase reconstruction （MPR） and CT angiography were performed after the scanning. The location and sizes of lesions, the range of invasion of adjacent vessels, swelling of lymph nodes of hilar and retroperitoneum, and hepatic metastasis were recorded. The results showed that only 8 lesions were found on CT plain scanning, and they were presented as hypodense nodules. All lesions were showed on contrast enhanced images. Five cases with infiltrating type were showed as focal wall thickness of hilar bile duct, ringlike enhancement appeared on arterial phase scanning, and the en- hancement was more apparent in portal venous and delayed phase scanning. Eight cases with intraductal growing type dem- onstrated as intraductal nodules, obvious enhancement was detected on delayed phase scanning, and the dilation of intrahepatic bile duct was also found. Seven cases of tumoral type showed as mass located in hilar region and involved adjacent vessels and partial hepatic parenchyma. Diffused or local dilation of bile duct could be seen on CT images. Combination of 2- and 3-dimensional reconstruction images can show more clearly of hilar cholangiocarcinoma lesions, invasion of hepatic arery or portal vein, segmental atrophy and metastasis of lymph nodes and liver. One-stop CT examination combined with axial multiphase dynamic contrast enhanced scanning with MPR and CT angiography of multidetector helical CT can clearly show the lesions of hilar cholangiocarcinoma, improve the preoperative tumor staging and help to design the surgical treatment.