原发性十二指肠腺癌MSCT表现

Multi-slice CT features of primary duodenal adenocarcinoma

目的:探讨原发性十二指肠腺癌MSCT三期增强扫描的影像学特征,总结分析其误诊、漏诊原因。方法:回顾性分析21例经病理证实的十二指肠腺癌的临床、病理及CT表现特征。结果:21例十二指肠腺癌中14例呈肿块型,表现为腔内息肉状或菜花状软组织肿块,边界清晰,多呈轻中度均匀强化;6例呈缩窄型,表现为肠壁不规则或环形增厚,肠腔狭窄,常伴有近段肠管扩张,边界清楚或毛糙,可突破浆膜面,呈中度或重度均匀、不均匀强化;1例因图像质量差难以评价。累及十二指肠乳头部的腺癌常伴有肝内外胆管、胰管扩张。21例十二指肠腺癌中正确诊断13例,3例误诊为十二指肠腺瘤,1例误诊为胰头癌,2例误诊为壶腹癌。2例因CT检查仅表现为肝内胆管轻度扩张而漏诊。1例肝内转移灶漏诊。结论:MSCT对十二指肠腺癌的诊断具有重要价值,保证十二指肠的充盈、重视门脉期对肝转移灶的检出以及肝内胆管轻度扩张这一间接征象,有助于更好地发现病变,降低误诊、漏诊率。

To analyze the findings of duodenal adenocarcinoma on triphasic contrast enhanced multi-slice spiral CT （MSCT）scan and the cause of misdiagnosis and missed diagnosis.Methods：Twenty-one patients with duodenal adenocarcinoma verified by histopathology were collected and their MSCT findings,clinical presentations and pathological data were retrospectively analyzed.Results：14 of 21 patients were mass-forming type appearing as a small intraluminal poly-poid protrusion or cauliflower-like soft tissue mass with sharp margin and mild to moderate contrast enhancement.Six of 21 cases were constriction type showing thickened duodenal wall and narrowed duodenal canal.The lesion could have clear or rough boundary,serosal invasion,moderate or intensive homogeneous or heterogeneous enhancement,often accompanied by proximal bowel dilatation.One case was difficult to evaluate because of poor image quality.Cases involving the duodenal pa-pilla often caused dilatation of the intrahepatic and extrahepatic bile ducts and pancreatic duct.Among the 21 cases,13 were correctly diagnosed,while three cases were misdiagnosed as duodenal adenomas,one as pancreatic cancer,two as ampullary cancer.Two cases were misdiagnosed because CT showed only mild dilatation of intrahepatic bile ducts.One case with liver metastases was missed.Conclusion：Multi-slice spiral CT can well display duodenal adenocarcinoma lesions with important diagnostic values.To make duodenal fluid-filling during CT scan,and to pay attention to find any liver metastases in portal phase and mild dilatation of intrahepatic bile ducts can help to better detect duodenal lesions and to reduce misdiagnosis rate.