正常十二指肠乳头MSCT及与十二指肠乳头癌的对照研究

Comparative Study of Multi-slice CT between Normal Duodenal Papilla and Duodenal Papillary Carcinoma

目的:探讨正常十二指肠乳头及十二指肠乳头癌的CT表现,以期为十二指肠乳头癌提供更多影像信息。方法:回顾性分析40例正常十二指肠乳头及经病理证实的12例十二指肠乳头癌的CT资料,所有检查者均行低张下多层螺旋CT扫描,比较分析其CT表现。结果:正常十二指肠乳头以类圆形居多(62.5%,25/40),主要位于十二指肠降段中下1/3后内侧壁(100%,40/40),最大径为(8.31±1.29)mm。增强扫描动脉期明显强化,门静脉期继续增强,平衡期强化程度减低,但仍高于平扫密度。十二指肠乳头癌表现为十二指肠乳头区分叶状、类圆形、椭圆形软组织肿块,最大径为(21.47±2.49)mm,多平面重建(MPR)及曲面重建(CPR)显示软组织肿块呈葫芦状(倒"3"字形)并突入十二指肠腔。增强扫描动脉期呈较均匀一致轻中度强化,门静脉期强化程度增加,平衡期强化程度减低。肝内外胆管扩张,胆囊增大,胆总管、胰管扩张并截断于乳头肿瘤,呈现"双管征"。结论:低张十二指肠充盈状态下壶腹部结构显示清晰,结合多平面重建(MPR)及曲面重建(CPR)技术有助于十二指肠乳头癌的诊断。

Objective:In order to provide more imaging information for duodenal papillary carcinoma,we explored the CT manifestations of the normal duodenal papilla and duodenal papillary carcinoma.Methods:We performed retrospective analysis on the CT data of 40 cases with normal duodenal papilla and 12 cases with duodenal papillary carcinoma confirmed by pathology,all the cases underwent hypotonic multi-slice spiral CT for the contrastive analysis of the CT manifestations.Results:Most of the normal duodenal papillas had round shapes,and were mainly located in the posterior-lateral inner wall of the middle-lower descending part of duodenum(100%,40/40),whose maximum diameter was(8.31±1.29)mm.Enhanced scan resulted in obvious enhancement in arterial phase,continued enhancement in portal venous phase and decreased enhancement in equilibrium phase,whose density was still higher that that of plain scan.In the cases with duodenal papillary carcinoma,we saw lobular,round or oval soft tissue masses in the duodenal papilla region,whose maximum diameter was(21.47±2.49)mm.MPR and CPR showed that gourd-shaped(Inverted"3")soft tissue masses protruded into the duodenal lumen.Enhanced scan resulted in homogeneous mild-moderate enhancement in arterial phase,increased enhancement in venous phase and decreased enhancement in equilibrium phase.The intrahepatic and extrahepatic bile ducts expanded,gallbladders magnified while the common bile duct and pancreatic duct expanded and got cut off at the papillary tumor,which showed“double duct sign”.Conclusion:The structure of ampulla under the filling state of hypotonic duodenum can be clearly displayed.The combination of multiplanar reconstruction(MPR)and curved surface reconstruction(CPR)is helpful to the diagnosis of duodenal papillary carcinoma.