3D CT成像对肝门胆管癌的可切除性评价

目的 探讨三维(3D)CT成像对评价肝门胆管癌可切除性的价值. 资料与方法 对17例经手术和病理证实的肝门胆管癌病例予以前瞻性分析.所有病例采用动脉期、门静脉期螺旋CT增强扫描.应用3D软件分别以最大强度投影(MaxIP)、最小强度投影(MinIP)和表面遮盖显示(SSD)行肝动脉造影(CTA)、肝静脉造影(CTV)、门静脉造影(CTP)及阴性对比CT胆管造影(nCTC),并作CTV、CTP与nCTC图像融合处理.由两名放射科医师和一名外科医师首先依据3D像对肿瘤分型做出判断,然后结合二维(2D)轴位像(AI)和多平面重组(MPR)分别观察肝血管及肿瘤有无转移,最后就肿瘤能否切除做出判断并与手术结果进行比较. 结果 CT对肿瘤分型的准确度为94.1%(16/17).MaxIP显示肝动脉(HA)主干及分支超过3级;门静脉(PV)、肝静脉(HV)主干及分支超过5级;SSD显示分别为2级、4级.2D像对观察肿瘤有无转移效果良好,3D像显示肝血管、胆管直观、清楚;融合像则对全面勾画肿瘤与肝血管、胆管的空间位置关系为佳.3D结合2D像对判断肿瘤能否切除的敏感性为80%(4/5),特异性为83.3%(10/12),准确性为82.4%(14/17). 结论 3D CT成像可整体显示肿瘤与扩张胆管及肝血管的关系,结合2D影像可作为评价肝门胆管癌能否切除的参考依据.

The Evaluation of Resectability of Hilar Cholangiocarcinoma with 3D CT

Objective To investigate the value of three dimensional(3D)CT imaging in evaluating the resectability of hilar cholangiocarcinomas.Materials and Methods17 cases with hilar cholangiocarcinomas confirmed by operation and pathology were prospectively analyzed.All patients received dual-phase helical CT after injection of 100 to 150 ml of nonionic contrast agent.3D CT arteriography(CTA),CT portography(CTP),CT venography(CTV),and negative-contrast CT cholangiography(nCTC)were generated with maximum intensity projection(MaxIP),minimum intensity projection(MinIP),and surface shadow display(SSD)models.Two radiologists and one surgeon individually assessed the tumor classification and weather or not the main hepatic artery(HA),portal vein(PV),and hepatic vein(HV)to being invaded by tumor on 3D images combined with two-dimensional(2D)axial image(AI)and multiplanar reformation(MPR).The resectability was then demonstrated by terms of an agreement judgment and compared to finally clinical outcomes.ResultsCT had an accuracy of 94.1%(16/17)in identifying the classification of hilar cholangiocarcinomas.The main HA,PV or HV and their branches shown on MaxIP were more than 3 grades,5 grades,respectively,and 2 grades,4 grades on SSD,respectively.Although 2D images allowed for visualization of metastases,3D images possessed advantages of depicting spatial relationship between the biliary trees and hepatic vessels.Combined with 2D images,3D images reached a sensitivity,specificity,and accuracy were 80.0%,83.3%,82.4%,respectively in evaluation of the resectability of hilar cholangiocarcinomas.Conclusion 3D CT imaging could directly delineate the relationship of tumor with the biliary tract,HA,PV and HV,which will make the surgeons to get referential evidences to determine the resectability of hilar cholangiocarcinomas combined with 2D images.