64排螺旋CT对十二指肠乳头疾病的诊断价值

Value of 64-row helical CT in diagnosis of duodenal papillary diseases

目的探讨64排螺旋CT对十二指肠乳头病变的诊断价值分析.方法选取2014-02/2017-08在义乌市中心医院住院的58例十二指肠乳头病变患者和30例十二指肠乳头未发生病变者进行研究,均行64排螺旋CT检查,主要观察乳头的最大横径、形态、强化模式和强化程度等变化情况.结果 58例十二指肠乳头病变中诊断为十二指肠乳头癌者38例,诊断为十二指肠乳头腺瘤者10例、诊断为十二指肠乳头息肉者4例,诊断为十二指肠乳头炎者6例.其中十二指肠乳头癌乳头横径最大为20.35 mm±6.8 mm;其次为十二指肠乳头腺瘤病变,横径为16.32 mm±6.04 mm;再者为十二指肠乳头息肉病变,横径为12.86 mm±2.56 mm;最后为十二指肠乳头炎病变,横径为9.34 mm±3.18 mm,正常乳头最大横径为5.26 mm±1.02mm.与正常十二指肠乳头最大横径比较,十二指肠乳头病变组明显增加(P<0.05);与十二指肠乳头癌乳头最大横径比较,十二指肠乳头腺瘤乳头最大横径差异无统计学意义(P=0.58,P>0.05).38例十二指肠乳头癌中有22例腺癌乳头呈类圆形,占57.89%,16例腺癌呈不规则型,占42.11%;10例十二指肠乳头腺瘤中8例乳头呈类圆形,占80.0%,2例腺瘤乳头呈不规则型,占20%.对十二指肠乳头腺癌、腺瘤、炎症和息肉在增强扫描各期CT值的均数做了对比分析,差异无显著性(P=0.112,P>0.05).38例十二指肠乳头腺癌中有30例呈均匀强化,占78.95%;10例十二指肠乳头腺瘤中有6例呈均匀强化,占60.0%.结论诊断十二指肠乳头部病变时要从其最大横径、形态和强化均匀程度等方面综合考虑,然后做出诊断,才可提高诊断的准确率.

AIM To assess the value of 64-row helical CT in the diagnosis of duodenal papillary lesions. METHODS Fifty-eight patients with duodenal papillary lesions treated at our hospital from February 2014 to August 2017 and 30 subjects without duodenal papillary lesions were included in this study. All subjects underwent 64-row helical CT examination to observe the maximum transverse diameter, shape of papillary lesion, pattern of enhancement, and the degree of enhancement. RESULTS Of 58 cases of duodenal papillary lesions, 38 were diagnosed as duodenal papillary carcinoma, 10 as duodenal papillary adenoma, 4 as duodenal papillary polyps, and 6 as duodenal papillitis. Duodenal papillary carcinoma had the largest maximum transverse diameter （20.35 mm ± 6.8 mm）, followed by duodenal papillary adenoma （16.32 mm ±6.04 mm）, duodenal papillary polyps （12.86 mm ± 2.56 mm）, duodenal papillonitis （9.34 mm ± 3.18 mm）, and normal duodenal papilla （5.26 mm± 1.02 mm）. The maximum transverse diameter of duodenal papillary lesions was significantly larger than that of normal duodenal papilla, while there was no significant difference between duodenal papillary carcinoma and duodenal papillary adenoma （P = 0.58, P 〉 0.05）. In 38 cases of duodenal papillary carcinoma, 22 （57.89%） were round in shape, and 16 （42.11%） had an irregular shape. In 10 cases of duodenal papillary adenoma, 8 （80.0%） were round and 2 （20%） were irregular. The average CT values of duodenal papillary adenocarcinoma, adenoma, inflammation, and polyps were comparable. Thirty-eight （78.95%） cases of duodenal papillary adenocarcinoma were uniformly enhanced. In 10 cases of duodenal papilloma, 6 （60.0%） were uniformly enhanced. CONCLUSION The diagnosis of a duodenal papillary lesion can be improved by comprehensive analysis of its maximum size, shape, and the degree of enhancement.