肝门胆管癌的MDCT诊断

目的:研究肝门胆管癌多排螺旋CT(MDCT)动态增强扫描的CT表现及薄层重建的诊断价值。方法:回顾性分析22例经手术及病理证实的肝门胆管癌的MDCT表现;所有病例均行平扫及动态增强扫描,准直器厚度为2.5mm,常规重建图像厚度和间隔均为6mm,肝门部位行层厚和间隔3mm薄层重建。结果:22例肝门胆管癌按CT表现形式分为肿块型、结节型和壁厚型,平扫所有病灶均表现为等低密度。肿块型特点为肝门肿块,动脉期表现为轻度不均匀边缘部强化,静脉期病灶强化更明显;结节型表现为肝门部<2cm的结节,动脉期主要为边缘明显环状强化,静脉期持续明显强化,且向中心部充填;壁厚型表现为肝门部胆管壁局限性不规则增厚>2mm,动脉期及静脉期均呈明显环状强化。86.3%的病例延迟强化。薄层3mm图像对显示病灶的部位、大小、强化特征及判断肝门部侵犯等均明显优于6mm图像,10min比3min延迟显示结节更清楚。结论:肝门胆管癌动态增强CT表现有明显特征性;MDCT10min延迟扫描及薄层重建可明显提高小病灶诊断正确性。

MDCT Diagnosis of Hilar Cholangiocarcinoma

Objective To study the expression of dynamic enhancement of CT scanning and the diagnostic value of thin thickness reconstrution in hilar cholangiocarcinoma.Methods The expression of MDCT of 22 cases with hilar cholangiocarcinoma proved pathologically were reviewed.All the cases were performed plain and dynamic enhancement CT scanning.The thickness of collimation was 2.5 mm.The thickness and interval of the routine image reconstruction was 6 mm.The hilar areas were performed thin reconstruction at the thickness and interval of 3 mm.Results According to the appearance of CT,we divided the hilar cholangiocarcinoma into mass type,nodular type and thick-walled type.All the cases appeared iso-hypodensity on plain CT scan.The character of mass type was hilar mass,slightly peripheral uneven enhancement on arterial phase,marked enhancement on venous phase.The feature of nodular type was hilar nodule less than 2 cm,marked marginal ring-like enhancement on arterial phase,marked delayed enhancement on venous phase and filled in the central part.Thick-wall type appeared irregularly thicken of the wall of bile duct at the hilar more than 2 mm,marked ring-like enhancement on arterial and venous phase,86.3% of case had delayed enhancement.On the presentation of size,location,character of enhancement and invasion of hepatic hilar,thickness with 3 mm images was better than that of 6 mm and delayed scanning with 10 minutes superior to that of 3 minutes.Conclusion There were marked character on dynamic enhancement CT;MDCT with 10 minutes delayed scanning and thin reconstruction can improve the accuracy of diagnosis on the small lesion of cholangiocarcinoma.