三期增强CT扫描对肝外胆管细胞癌的诊断价值

Diagnostic value of CT three phases enhancing scan on extrahepatic cholangiocarcinom

目的肝外胆管细胞癌(extrahepatic cholangiocarcinoma,EC)生长慢,瘤体小,预后差,早期不易被发现,一直是临床及影像诊断的难点。本研究旨在探讨其CT三期增强扫描的强化特点及量化指标。方法回顾性分析2005-07-23-2015-09-18合肥市第二人民医院和解放军105医院15例经手术病理确诊为EC患者CT图像特征,所有病例均行平扫及三期动态增强扫描,并以肿瘤与邻近正常肝脏或胰腺的CT值比值作为病灶强化的量化指标。结果肝门区胆管癌12例,胆总管胰头区胆管癌3例。管壁浸润型11例,肿块形成型4例。延迟期13例比值>1,且均高于其他各期的比值,表现为不同程度延迟强化;1例表现为三期呈持续性较明显强化,动脉期比值高于其他各期;1例表现为门脉期比值高于其他各期。通过使用SPSS软件分别对平扫,动脉期,门脉期以及延迟期的CT值比值进行正态性检验(P>0.05),显示数据符合正态分布。经过统计学分析发现延迟期的CT值比值显著高于动脉期和门脉期,P<0.01。结论 CT增强延时强化是肝外胆管细胞癌的重要特征,三期增强扫描肿瘤与邻近正常肝脏或胰腺的CT值比值,可以作为病灶强化与可显示度的量化指标。

OBJECTIVE Due to the slow growth of extrahepatic cholangiocarcinoma,as well as the small tumors and poor prognosis,it is difficult to be diagnosed in early stage,which has always been a problem of clinic and imaging diagnosis.This research aims at exploring the enhanced features and quantitative index of CT three-phase enhanced scan in extrahepatic cholangiocarcinoma.METHODS CT image features of 15 cases collecting from Hefei Second People＇s Hospital and the PLA 105 Hospital from July 23,2005 to September 18,2015 diagnosed as extrahepatic cholangiocarcinoma confirmed by surgery and pathology were retrospectively analyzed.All the cases were checked by CT plain scan and triphasic dynamic enhanced scan,and the ratio of CT values between tumor and adjacent normal liver or pancreas was set as a quantitative index of lesions enhanced.RESULTS There were 12 cases of biliary duct cancer in hepatic hilar region,3 cases of pancreas head region of choledoch.Eleven cases were wall infiltration,and 4 cases were lump forming.The ratios of CT values in delayed-phase were greater than 1 and higher than those in arterial-phase and portal-phase in 13 cases,indicating delayed enhancement to different degrees.Relatively significant continuously enhancement was shown during three phases and the ratio of CT values in arterial-phase was the highest in 1 case.In addition,the ratio of CT values in portal-phase was the highest in another one case.SPSS software was used to test the CT value of plain scan,arterial phase,portal phase and delayed phase respectively,showing normal distribution of data（P〈0.05）.It was found that the ratio of CT values in delayed-phase were significantly higher than those in arterial-phase and portal-phase（P〈0.01）by statistical analysis.CONCLUSIONS CT enhanced delay reinforcement is an important character of extrahepatic cholangiocarcinoma.The CT value ratios between tumor and adjoining normal liver or pancreas of three phases enhanced scan can be used as the quantitative index of lesions enhanced and displayable degree.