23例原发性十二指肠腺癌多层螺旋CT图像表现及鉴别诊断研究

Multislice Spiral CT(MSCT) Images and the Differential Diagnosis for Primary Duodenal Adenocarcinoma in 23 Cases

目的 研究原发性十二指肠腺癌多层螺旋CT(MSCT)图像表现及鉴别诊断。方法 收集本院2016年3月至2019年5月收治23例原发性十二指肠腺癌患者的临床资料。对患者所得图像进行分析,以病理检查结果为基准,分析MSCT检查对原发性十二指肠腺癌患者诊断符合率。结果 MSCT对原发性十二指肠腺癌诊断符合率为91.30%,与病理检查结果一致性高(P>0.05);在MSCT平扫表现:肿瘤可突入患者腔内,为不规则或者是息肉样的肿瘤,多数患者伴有肠壁增厚的情况,在增强扫描时肿块为明显强化;降段发病率为65.21%(15/23);23例患者中其中1例患者可见十二十二指肠水平段壁增厚,管腔僵硬,而管腔狭窄其上方十二指肠球部及降部扩张情况;11例患者有肝内外胆管扩张,3例患者伴近段肠管扩张;6例胰胆管扩张;有1例可见钙化;淋巴结转移3例。结论 MSCT可了解原发性十二指肠腺癌的肿瘤大小、周围浸润及转移情况等,可为临床术前诊断、治疗方案选择提供重要参考依据。

Objective To study the multislice spiral CT(MSCT) images and the differential diagnosis for primary duodenal adenocarcinoma. Methods The clinical data of 23 patients with primary duodenal adenocarcinoma admitted in our hospital from March 2016 to May 2019 were collected. The images of the patients were analyzed, and the accuracy of MSCT in the diagnosis of primary duodenal adenocarcinoma was analyzed based on the results of pathological examination. Results The diagnostic accuracy of MSCT for primary duodenal adenocarcinoma was 91.30%, and the consistency with the results of pathological examination was high(P>0.05). In MSCT plain scan: The tumor can protrude into the patient’s cavity. It is irregular or polyp-like. Most patients were accompanied by thickening of the intestinal wall. The mass s significantly strengthened in enhanced scanning. The morbidity of descending segment was 65.21%(15/23);Of the 23 patients, one patient showed that the horizontal section of the wall of the duodenum was thickened, the lumen was stiff, and the duodenal bulb and descending area were dilated above the lumen stenosis. Eleven patients had intrahepatic and extrahepatic cholangiectasis, 3 patients were accompanied with proximal intestinal dilatation;6 had pancreaticobiliary dilatation;1 had calcification;And 3 had lymph node metastasis. Conclusion MSCT can display the tumor size, peripheral invasion and metastasis of primary duodenal adenocarcinoma,and can provide important reference for the of selection preoperative diagnosis and treatment plan.