CT动态增强扫描在胆囊癌诊断与鉴别诊断中的应用

目的 分析CT动态增强扫描在胆囊癌的诊断与鉴别中的作用,为临床治疗提供参考.方法 收集2007年6月～2012年6月浙江省衢州柯城区人民医院和浙江大学医学院附属第一医院治疗的47例胆囊癌患者临床资料,对经病理证实的患者进行CT多期增强扫描,分析CT增强表现.结果 在47例胆囊癌中,有43例显示出较中心区域更快的边缘强化,而胆囊息肉的患者未表现出上述强化方式;经过分析后,良、恶性肿瘤边缘-中心强化速度比差异有统计学意义（t=4.327,P＜0.05）,最大强化速率两者差异无统计学意义（t=1.038,P＞0.05）.47例胆囊癌增强扫描表现为：①增厚型15例,增强后可见强化均匀.②结节型21例,增强后明显均匀强化,门脉期和延迟期结节持续强化.③肿块型7例,增强后呈不均匀强化,以周边强化更为明显,其中动脉期较其他各期表现更明显.④混合型4例,增强后病灶中心轻度强化,边缘中度以上强化.结论 CT动态增强扫描具有良好的分辨率,明显的肿瘤影像特征,对胆囊癌的诊断、治疗和预后具有重要的参考价值.

Application of CT dynamic enhanced scanning in gallbladder diagnosis and differential diagnosis

Objective To analyze the role of dynamic enhanced CT scanning in the diagnosis and identifiication of gallbladder carcinoma,and to provide reference for clinical treatment of gallbladder carcinoma.Methods Clinical data of 47 cases of patients with gallbladder carcinoma treated in Kecheng District People＇s Hospital of Quzhou and the First Hospital Affiliated to School of Medicine of Zhejiang University from June 2007 to June 2012,the patients confirmed by pathology were subjected to mutiperiodic enhanced CT scanning,and CT enhanced performance analyzed.Results 43 cases of patients among 47 cases of patients with gallbladder carcinoma showed a faster edge enhancement when those were compared in the central zone,and gallbladder polyp patients did not show that enhanced method; after analysis,benign or malignant tumor edge-centeral strengthed velocity ratio was statistically difference （t =4.327,P ＜ 0.05）,the maximum strengthened rate in both two group was statistical different （t =1.038,P ＞ 0.05）.47 cases of gallbladder carcinoma enhanced scannings showed as following：①15 cases of gallbladder carcinomas were found,the unform enhancement of gallbladder carcinoma was visible.② 21 cases of gallbladder carcinomas showed nodular type,obvious homogeneous enhancement was available after being intensified,nodules during the portal phase and delay period continually strengthened.③7 cases of patients of lump types,uneven enhancement was shown after intensifying,perimeter reinforcement was more apparent,in which the performance of arterial phase was more obvious than that in other stages.④4 cases of mixed,lesions center was mildly strengthed after the enhancement,the edge was reinforced moderately and more violently.Conclusion Dynamic enhanced CT scanning is provided clear resolutio and obvious tumor imaging features,imposing important reference value on the diagnosis,treatment and prognosis of the gallbladder carcinoma.