十二指肠乳头腺癌64例低张MSCTE的影像学特征分析

Imaging feature analysis of hypotonic MSCTE in 64 cases of duodenal papillary adenocarcinoma

目的分析低张多层螺旋计算机断层扫描小肠造影(multi-slice computer tomography enterography,MSCTE)检查十二指肠乳头腺癌的影像征象及低张MSCTE对十二指肠乳头腺癌的诊断价值。方法回顾性分析经病理证实64例十二指肠乳头腺癌的影像学特征。结果64例患者中,57例十二指肠乳头腺癌体积较小(直径≤3 cm),3.1~4.0 cm 7例。形态的变化差异较大,47例形态规则,17例不规则。5例体积较大肿瘤内出现液化坏死,液化坏死区在动脉期和门脉期显示清晰,延迟期边界模糊。29例类圆形结节出现靶征,不仅在动脉期,门脉期、延迟期也会出现,病变在不同层面靶征可连续或不连续,其中2例靶征连续,27例靶征不连续。59例胆管呈软腾样扩张。32例胰管扩张,其中30例是胰胆管同时扩张,2例仅胰管扩张。32例胰管扩张中14例分支胰管扩张呈“多管征”,可清晰显示副胰管汇入副乳头。3例胰胆管同时不扩张。27例胆总管下端平直截断,14例呈鸟嘴样狭窄,8例见结节突入管腔呈杯口样充盈缺损。低张MSCTE术前判断27例十二指肠腺癌侵犯肠壁深肌层及浆膜层,8例侵犯胰腺,6例淋巴结转移,2例肝脏转移,2例分别并发胃癌、胆囊癌。结论低张MSCTE对十二指肠乳头腺癌直接征象、胰胆管扩张情况及其周围器官的组织显示具有特征性,可提高筛查率和诊断准确率。

Objective To analyze the imaging features of duodenal papillary adenocarcinoma examined by multi-slice computer tomography enterography(MSCTE),and to explore the diagnostic value of hypotonic MSCTE in duodenal papillary adenocarcinoma.Methods The imaging features of 64 cases of duodenal papillary adenocarcinoma confirmed by pathology were retrospectively analyzed.Results Of 64 patients,fifty-seven cases had smaller size of duodenal papillary adenocarcinoma(diameter≤3 cm),7 cases with diameter 3.1~4.0 cm.But the changes of tumor morphology were quite different,including regular morphology in 47 cases and irregular morphology in 17 cases.5 cases had liquefaction necrosis in larger tumors.The liquefaction necrosis area was clearly displayed in arterial and portal phases,and the boundary of delayed phase was blurred.29 cases showed target sign in round nodules,not only in arterial phase,but also in portal phase and delayed phase.The target sign of lesions could be continuous or discontinuous at different levels.Of the 29 cases,2 cases showed continuous target sign,and 27 cases showed discontinuous target sign.59 cases showed soft tenuous dilatation of bile duct.32 cases showed pancreatic duct dilatation,among whom 30 cases had simultaneous dilatation of pancreaticobiliary duct,and 2 cases had only dilatation of pancreatic duct.Among the 32 cases with pancreatic duct dilatation,10 cases showed“multi-duct sign”of pancreatic head branch pancreatic duct dilatation,and clearly showed accessory pancreatic duct influx into accessory papilla.3 cases had no dilatation of pancreaticobiliary duct.27 cases had straight truncation of the lower end of common bile duct,and 14 cases had bird-bill-like stenosis,and 8 cases had cup-like filling defect when nodules protruded into the lumen.MSCTE preoperative judgement showed duodenal adenocarcinoma invading deep muscular layer and serosa layer of intestinal wall in 27 cases,invaded pancreas in 8 cases,lymph node metastasis in 6 cases,liver metastasis in 2 cases and concurrent gastric cancer and gallbladder cancer in 2 cases.Conclusion MSCTE can improve the screening rate and diagnostic accuracy of duodenal papillary adenocarcinoma through its direct signs,dilatation of pancreaticobiliary duct and the display of its surrounding organs and tissues.