十二指肠肿瘤的影像学诊断和评价

Imaging diagnosis and evaluation in duodenal neoplasms

目的 :评价CT和钡剂造影 (GI)诊断和鉴别诊断十二指肠肿瘤的价值。方法 :42例十二指肠肿瘤 (腺癌 2 8例 ,平滑肌肉瘤 6例 ,恶性淋巴瘤 1例 ,腺瘤 2例 ,平滑肌瘤 3例 ,脂肪瘤 2例 )的临床特征 ,CT和GI表现对照病理所见进行分析。对各影像学方法 (CT、GI、CT +GI)在显示病变 ,定形 (明确病变的确切部位、大小、形态 )和定性诊断与鉴别诊断中的作用 ,以 0～ 3分记分法进行评价。结果 :十二指肠肿瘤的主要临床表现为肠腔占位 (2 3.81% )、肠道出血 (11.90 % )和黄疸(38.10 % )三大类。它与病变部位关系密切 ,而与病变的良恶性及其大小并不一致。 2 5例兼做CT和GI者中 ,CT敏感性最高 ,10 0 %可发现病变。 1例球后段癌阻塞肠道GI无法诊断 ,敏感性为 97.6 2 %。但GI特异性 (3分 )为 6 0 .0 % ,CT仅5 2 0 % ,CT +GI则可达 92 .0 %。结论 :CT和GI诊断与鉴别诊断十二指肠肿瘤各有利弊 ,综合二种技术 ,可提高诊断正确性。

Objective:To assess the value of CT and gastrointestinal barium examination(GI)in diagnosing and differentiating duodenal neoplasms.Methods:The clinical features,CT and GI characteristics of 42 cases of duodenal neoplasms including 28 adenocarcinomas,6 leiomyosarcomas,1 malignant lymphoma,2 adenomas,3 leiomyomas and 2 lipomas were compared with the pathologic findings.The value of imaging modalities(CT,GI,CT+GI)were evaluated and the three point score was made according to their ability in detercting lesions;determining their size,sharp ,and property;diagnosing and differentiating the lesions.Results:The main clinical findings of duodenal tumors were occupation(23.81%),intestinal bleeding(11.90%),and jaundice(38.10%).The symptoms were related to the location of the tumors,and not consistent with their size and benign or malignant property.The diagnotic values of imaging modalities were evaluated in 25 cases which were examined by CT and GI concurrently.The outcome showed that the sensitivity of CT and GI was 100% and 97 62% respectively and the specificity (3 scores) of CT+GI(92.0%) was significantly improved than those of CT(52.0%)and GI(60 0%)individually.Conclusion:CT and GI have their own advantages and disadvantages in diagnosing and differentating duodenal neplasoms.CT combined with GI may increase the diagnostic accuracy.