超声间接征象在诊断肝外胆管癌中的价值分析

目的探讨超声间接征象在诊断肝外胆管癌中的临床意义。方法选自2001年12月至2007年12月间,经CT、MR及手术证实的72例肝外胆管癌病例。空腹常规超声检查肝胆胰脾。重点观察梗阻段胆管及近段胆管扩张情况和相关器官继发改变的超声间接征象,详细记录并留存图像信息,随访临床结果作对照分析。结果72例肝外胆管癌病例中,全部具有近段胆管扩张,显著扩张64例,中度扩张7例,轻度扩张1例。本组胆管扩张的显示率为100%。依据梗阻段胆管狭窄的程度与形态、近段胆管扩张的程度与范围、扩张段与狭窄段胆管的移行状态等超声间接表现,判断梗阻部位的准确率为97.22%（70/72）,病因提示其诊断相符率为94.44%（68/72）。结论注重超声间接征象表现,无疑对梗阻部位的判定及病因的提示性诊断皆有重要临床价值。     

影像学技术在肝门部胆管癌诊断和治疗中的价值评估

［摘要］　目的　探讨超声、CT、MRI/MRCP等影像学技术在肝门部胆管癌的诊断和治疗中的临床应用价值。方法　分析肝门部胆管癌的病例,统计分析超声检查、CT检查、MRI/MRCP检查对肝门部胆管癌的定性、定位、分型、血管侵袭、转移等方面的诊断符合情况。结果　CT检查、MRI/MRCP检查比超声检查的正确率高。结论　影像学检查在肝门部胆管癌诊断及治疗中有重要临床应用价值。     

64排螺旋CT在肝外胆管癌诊断中的临床应用

目的探讨64排螺旋CT三期增强扫描和三维重建在肝外胆管癌中的诊断价值。方法对20例经手术病理或活检证实的肝外胆管癌患者,分别行动脉期、门脉期和延迟期扫描及重建薄层图像。结果 11例肝门部胆管癌位于左肝管3例、右肝管2例,肝总管端6例。11例均有肝内胆管呈蟹足状,藤状改变。肝门区均见软组织肿块影。增强早期肿块强化不明显,肿块内呈低密度影3例。延迟扫描胆管癌肿块全部强化者9例,呈不均匀强化者2例;9例胆总管癌均显示扩张胆总管突然中断或变形,其中4例管壁可见环形不均匀增厚,管腔狭窄,2例腔内见结节状软组织影,2例腹膜后见肿大淋巴结。结论 64排螺旋CT三期增强扫描及三维重建是诊断肝外胆管癌的理想检查手段。     

磁共振胆胰管造影联用动态增强对胆管癌的诊断价值

目的：评价屏气磁共振胆胰管造影(MRCP)及联合应用动态增强MRI对胆管癌的临床诊断价值。方法：回顾性分析88例经手术、病理证实的胆管癌的MRCP及动态增强MRI表现。结果：88例检查均一次成功，全部病例胆胰管显示满意。MRCP对肝门型胆管癌和肝外胆管型胆管癌的定位诊断准确率均为l00％，定性诊断准确率为100％和52．2％，结合动态增强MRI扫描，对肝外胆管型胆管癌定性诊断准确率提高到91．3％。结论：MRCP检查成功率高，对肝门型胆管癌和肝外胆管型胆管癌定位准确，结合动态增强MRI扫描，定性诊断也有较高准确性。     

B超结合螺旋CT在肝胆管结石合并肝胆管癌术前诊断中的价值

目的:探讨B超结合S-CT在肝胆管结石并发肝胆管癌临床诊断中的应用价值。方法:总结30例肝胆管结石合并肝胆管癌患者B超、CT影像特点,并与手术病理进行对照分析。结果:①本组病例B超诊断率为59.3％,CT诊断率为73.3％,两者结合诊断准确率达80％。②本病的B超表现特点为:含结石肝内胆管扩张,受累肝叶纤维化;肝内可见回声不均的结节或肿块,胆管腔内见实体或乳头状肿物;肛管腔内可见粘液状物回声;肝门区有淋巴结肿大。局限性:左肝外叶肿瘤易受胃肠气干扰;小瘤肿易被结石声影掩盖;胆管内微小癌超声难以显示;癌性与炎症性胆管壁增厚、瘤内坏死液化与肝脓病在超声上均不易鉴别。③本病CT影像特点:肝内胆管不同程度扩张,并含结石;肝内可见低密度占位,增强后有轻度或部分强化,肿块内可见结石嵌顿;肝内胆管可见软组织影充填,肝门部可见肿大淋马结。局限性:胆管内较小乳头状瘤,局限性胆管壁癌性增厚,不形成肿决的肝内胆管弥漫性病变,少数不强化的肝内等密度占位病变等,CT均较难诊断。结论:B超与CT相结合在肝胆管结石合并肝胆管癌的临床诊所上具有重要价值。对于长期反复发作的肝胆管结石患者,均应行B超及CT检查:CT影像对于肿瘤术前定位,决定病灶...     

肝门胆管癌的超声影像学诊断

0引言肝门胆管癌是发生在肝总管和左右肝管汇合处及其近侧上1/3段的恶性肿瘤,其发生率在胆管癌中最高占40-76%[1].鉴于其预后、手术方式及术前影像学诊断与中下1/3段胆管癌不尽相同,应用灰阶和彩色多普勒超声检查(gray-scale and color doppler ultrasonography以下简称U/S)对肝门胆管癌作出评价[2-21].1肝门胆管癌的U/S检出率与符合率参照U/S对黄疸和阻塞性黄疸的鉴别诊断指征.(1)依据肝内胆管扩张,首先判断和提示阻塞性黄疸符合率为100%.(2)梗阻部位判断,U/S提示肝门水平梗阻符合率100%,包括左右肝管汇合水平,胆囊管开口以上肝总管水…     

15例肝门区胆管癌的CT影象诊断

目的评价CT在肝门区胆管癌诊断中价值.方法搜集15例经手术和病理证实的肝门区胆管癌,分析肿瘤的CT表现并与手术所见和病理相对照,评价CT在肝门区胆管癌的诊断价值和判断肿瘤周围累及范围的准确性.结果本组15例中术前13例CT诊断为肝门区胆管癌,确诊率为86.7%.CT表现6例CT平扫表现为肝门区低密度软组织肿块,增强后2例轻度强化,其余无强化;8例表现为肝门区胆管壁不规则增厚,管腔狭窄,增强后增厚的管壁可有轻度的强化;2例因胆管壁均匀轻度增厚而误诊为胆管炎.CT发现肝脏浸润或转移8例,术中和病理确诊12例;CT发现肝动脉浸润1例,门静脉浸润4例,术中发现肝动脉受浸4例,门脉受累7例;CT显示1例胆囊受累,术中发现4例;CT明确3例肝门区淋巴结转移,5例可疑转移,手术和病理证实9例;6例腹膜后淋巴结转移,5例CT明确诊断;5例肝门脂肪浸润,CT仅显示1例;其他2例神经受浸,2例腹膜种植在CT上均不明确.CT在判断肿瘤周围累及范围的准确性为53%.结论CT在检出和识别肝门区胆管癌中有重要的价值,在判断肿瘤周围浸润的程度时仍有一定局限性.     

刮吸解剖法在肝门胆管癌手术切除中的应用

0引言肝门部胆管癌又称上段胆管癌或高位胆管癌,指原发于左右肝管及其汇合部和肝总管的癌肿.占肝外胆管的50-75%.1965年Klatskin报告13例源于肝门肝管分叉部的胆管腺癌的临床病理特征,故肝管分叉部癌常称为Klatskin瘤.现已达成共识凡侵犯肝门肝管分叉部的癌肿,不论其源于肝外胆管或肝内胆管,都归为肝门部胆管癌.肝门胆管癌的发病率有逐年上升的趋势,近年来已逐渐受到外科界的重视,由于肿瘤位于第一肝门,与门静脉和肝动脉紧密相邻,并且部分掩盖于肝实质中,手术显露比较困难,以致手术切除存在相当的难度和危险,因此国内文献多仅讨论高位胆管…     

胆管腔内超声对胆管狭窄的病因诊断价值探讨

目的探讨胆管腔内超声(IDUS)对胆道狭窄病因诊断的价值。方法应用微型超声探头通过ERCP、经皮经肝胆管造影及手术中直接插管3种途径对32例胆管狭窄病变进行IDUS检查。结果32例胆管狭窄患者中IDUS诊断胆总管癌16例,左肝管癌2例,壶腹癌3例,高位胆管癌1例,慢性胆总管炎6例,胆总管结石2例,胆总管囊肿2例。胆总管癌诊断准确率93.8%,慢性胆总管炎、壶腹癌、肝管癌、胆总管囊肿和胆管癌准确率为100%。结论IDUS对胆管狭窄病因诊断有特殊的价值,通过胆管狭窄不同病变声像图的特征,可以鉴别胆管良、恶性病变,并可判断胆管癌、乳头癌的浸润程度以指导治疗。     

华支睾吸虫肝病肝胆管改变的CT与病理分析

目的评价华支睾吸虫肝病肝胆管改变的CT诊断价值及其病理改变.方法98例本病患者中,男57例,女41例.95例(97%)有明确食生鱼史,就诊时腹痛48例,右上腹闷胀15例,腹部不适22例,发热5例,黄疸8例.肝功能检查中谷丙转氨酶(ALT)升高者9例,碱性磷酸酶(AKP)轻度升高者8例,总胆红素升高5例(>15.5μmol/L),直接胆红素升高14例及间接胆红素升高12例.所有病例均于粪便及十二指肠引流中发现虫卵,其中89例华支睾吸虫血清学检查为阳性,9例肝胆手术治疗,8例做肝活检.本组病例全部呈肝内胆管扩张改变,大便阳性而肝CT检查正常者未选入本组病例.结果98例CT均显示不同程度的肝内胆管扩张,轻度扩张62例(63.3%),中度23例(23.5%),重度13例(13.3%).肝内胆管扩张的形态分三种类型Ⅰ型扩张的肝管从肝门向肝被膜下方向逐渐扩张,其肝被膜下小胆管呈囊状扩张者82例(83.7%);Ⅱ型肝内胆管从肝门向肝被膜下逐渐扩张,但无肝被膜下小胆管囊状扩张者12例(12.2%);Ⅲ型肝内扩张的胆管,肝门侧与远侧端胆管径宽度相近似者4例(4.1%).98例中6例(6.1%)显示部分扩张,胆管壁不规则,管腔粗细不均,边缘较模糊;12例(12.2%)肝内胆管近肝门侧明显扩张,而远端扩张不明显.98例中91例(92.9%)肝外胆管无扩张.增强扫描显示更为清晰,肝内、外胆管壁均未发现增厚及异常强化征象.肝内胆管结石18例(18.4%),其中肝左叶内8例,肝右叶内6例,肝左、右叶内均有结石者4例,肝总管、胆总管结石各1例,胆囊结石5例,数目不定.胆囊炎28例,4例(4.1%)胆囊内见团状或不规则软组织密度条状物悬浮于胆汁中,胰管轻度扩张2例.肝左叶增大.8例肝活检镜下见胆管腺瘤样增生,符合华支睾吸虫所引起的胆道系统的病理改变.9例术中见肝表面有散在的黄白色扩张的小胆管,其中并发肝细胞癌1例,肝胆管上皮癌3例,脂肪肝1例,肝囊肿1例.结论①华支睾吸虫所致肝内胆管从肝门向被膜方向逐渐扩张,管径大小相近,这种扩张形式是其所特有的,CT具很高的诊断价值.②长期反复及大量寄生华支睾吸虫病可并发一些恶性疾病,对其早诊断早治疗,颇具临床意义.     

超声检查门静脉海绵样变特征表现

目的 探讨门静脉海绵样变(CTPV)及其相关并发症的超声表现特征,并分析了超声漏诊的原因。方法 2017年6月～2020年6月首都医科大学附属北京地坛医院诊治的101例CTPV患者,经CT和MRI增强扫描诊断,接受腹部超声检查。总结CTPV及其相关并发症超声图像表现特征,并分析超声漏诊的原因,提出解决策略。结果 在本组101例CTPV患者中,超声诊断82例(82.2%),漏诊19例(17.8%);在超声诊断病例中,82例(100.0%)患者门静脉主干及其分支周围出现广泛或局部蜂窝状粗细不等的血管结构,70例(85.4%)出现门静脉管壁增厚,76例(92.7%)在迂曲扩张的蜂窝状血管结构内部呈红蓝相间的丰富的血流信号,脉冲多普勒测得门静脉样低速血流频谱,10例(12.2%)门脉周围迂曲扩张蜂窝状血管压迫胆管,导致胆管扩张,8例(9.6%)出现胆囊增大,6例(7.4%)出现胆囊结石,5例(6.1%)出现胆管结石,5例(6.1%)出现门体分流。结论 超声是诊断CTPV的首选影像学方法,超声漏诊的原因主要为海绵样变血管腔细、病变范围小,腹部胀气,假性胆管肿瘤征,肋间隙或胸骨下角窄。利用腹腔积液和胆囊等声窗扫查肝脏,采用超声造影技术或结合其他影像学技术检查可减少漏诊。     

MSCT重建技术在胰腺癌术前评估中的应用

目的 探讨多层螺旋CT（MSCT）重建技术在胰腺癌手术可切除性评估中的应用价值.方法 回顾性分析35例经手术证实的胰腺癌患者的多期增强CT图像及包括容积重建（VR）、多平面重建（MPR）、曲面重建（CPR）等的后处理方法,重点观察胰腺肿瘤与周围结构、邻近血管、胆管的关系,进行肿瘤能否手术切除的评估,并与实际手术的结果进行对比.结果 35例患者中9例共27支血管受侵犯;19例总胆管、12例胰管受侵犯;7例十二指肠受侵,2例胃后壁受侵,1例脾肿大伴区域性门脉高压;14例次胰头周围淋巴结肿大,4例次腹主动脉旁淋巴结肿大,3例肝转移.CT术前评估手术可切除21例,最终19例行胰腺癌根治术,2例行姑息术;术前评估手术不可切除14例,均行姑息术.根治术、姑息术术前评估与术后结果符合率分别为90％、88％.结论 MSCT重建技术能提高对胰腺癌局部侵犯、转移的诊断,可提高对肿瘤可切除性的评估.     

Preoperative assessment of extrahepatic bile duct carcinoma using three-dimensional intraductal US.

BACKGROUND: We investigated the utility of a new imaging modality, three-dimensional intraductal ultrasonography (US), for staging bile duct cancer. METHODS: In eight patients with extrahepatic bile duct carcinoma, two- and three-dimensional intraductal US was used to assess tumor invasion of the right hepatic artery, portal vein, and pancreatic parenchyma before resection. The findings were correlated with histologic information from the resected specimen. RESULTS: Three-dimensional intraductal US enabled accurate assessment of tumor invasion of the right hepatic artery in 88% of cases, the portal vein in 100%, and pancreatic parenchyma in 100%. Two-dimensional intraductal US enabled accurate assessment of invasion of these structures in 88%, 88%, and 88% of cases. CONCLUSIONS: Three-dimensional intraductal US is useful in assessing tumor stage in bile duct carcinoma.     

Ultrasound Visualization of Hepatic Peribiliary Cysts: A Comparison with Morphology

We report herein a hitherto unrecognized, interesting ultrasound finding ("hilar multicystic echo complex"), the result of peribiliary cysts in the liver. This ultrasound finding was discovered around intrahepatic large bile ducts and large portal vein branches near the hepatic hilum in an autopsy case with hepatocellular carcinoma, submassive hepatic necrosis superimposed on chronic active hepatitis, and portal hypertension. Antemortem ultrasound examination revealed the hilar multicystic echo complex around the portal venous branches near the hepatic hilum. Autopsy confirmed that the hilar multicystic echo complex was due to peribiliary cysts that were present around the bile ducts at the hilum. The peribiliary cysts were thought to have arisen from cystic dilatation of preexisting intrahepatic peribiliary glands. These peribiliary cysts reportedly occur in livers with portal hypertension (e.g., cirrhosis, hepatocellular carcinoma, idiopathic portal hypertension, extrahepatic portal obstruction, and portal thromboembolism), adult-type polycystic disease of the liver and kidneys, and systemic infection. Therefore, recognition of peribiliary cysts at sonography would have diagnostic value, and may indicate that presence of one of the above described liver diseases.     

自身免疫性胰腺炎的CT和MRI影像学征象

目的 探讨自身免疫性胰腺炎(autoimmune pancreatitis,AIP)的CT及MRI影像学表现特征.方法 回顾性分析14例经组织学和(或)类固醇激素治疗证实的AIP患者的CT及MRI资料.10例行CT检查,7例行MRI检查(其中3例同时做CT和MRI检查).结果 11例AIP表现为胰腺弥漫性肿大,3例为胰腺局限性肿大.10例CT平扫见胰腺病变区密度均降低,5例显示节段性胰管,5例见胆总管胰头段狭窄;7例在胰腺病变区周围可见环绕包膜样结构;动态增强后出现延迟均匀强化.7例MRI的抑脂T1WI显示胰腺病变后信号均匀降低(3例)或不均匀降低(4例),抑脂T2WI信号均匀增高(3例)或不均匀增高(4例);4例MRI显示胰管,MRCP见1例胰头部胰管局限性狭窄,2例胰管节段性狭窄;5例MRI见胆总管胰头段狭窄,MRCP见3例胆总管胰头段呈鸟嘴样狭窄;6例见胰腺病变区周围环绕包膜样结构.14例AIP均未见胰腺实质钙化,胰管均未见明显扩张(＞3 mm).结论 AIP的CT、MRI表现具有特征性,主要为胰腺呈腊肠样改变,胰周出现包膜样结构,胰管弥漫性或局限性狭窄,胆总管胰头段炎性狭窄.     

肝脏局灶性结节增生CT、MRI征象和病理特点的综合分析

目的探讨肝脏局灶性结节增生（FNH）的CT、MRI征象和病理特点。方法回顾性分析经手术切除病理证实为FNH病例15例,其中7例术前行多层螺旋CT平扫及多期增强扫描,另8例行MR平扫及多期增强扫描。结果15例病灶多呈类圆形、椭圆形,少数呈分叶状;病灶直径3．0～8．0cm;病灶的边界在平扫时显示模糊,增强后显示清楚;CT平扫病灶多呈稍低或等密度,中心部分瘢痕结构呈更低密度,增强后动脉期病灶实质部分多明显均匀强化,瘢痕结构未见强化,门静脉期和延迟期实质部分强化程度下降呈稍低或等密度,瘢痕结构延迟强化,其中4例瘢痕结构可见;MRI平扫病灶呈稍长或等T1WI及T2WI信号,瘢痕结构于T2WI上呈特征性高信号,增强后三期信号变化特点类似CT三期增强特点,其中5例瘢痕结构可见;9例增强后病灶内或周围可见增粗、扭曲的动脉,在T2WI上表现为血管流空。结论熟悉FNH多种影像征象,可提高FNH术前诊断率。CT和MRI能够反映FNH病理特点及血供血管情况,可为临床选择手术方案提供重要参考。     

CEUS： A new imaging approach for postoperative vascular complications after right-lobe LDLT

AIM： To investigate contrast-enhanced ultrasound （CEUS） for early diagnosis of postoperative vascular complications after right-lobe living donor liver transplantation （RLDLT）. METHODS： The ultrasonography results of 172 patients who underwent RLDLT in West China Hospital, Sichuan University from January 2005 to June 2008 were analyzed retrospectively. Among these 172 patients, 16 patients＇ hepatic artery flow and two patients＇ portal vein flow was not observed by Doppler ultrasound, and 10 patients＇ bridging vein flow was not shown by Doppler ultrasound and there was a regional inhomogeneous echo in the liver parenchyma upon 2D ultrasound. Thus, CEUS examination was performed in these 28 patients. RESULTS： Among the 16 patients without hepatic artery flow at Doppler ultrasound, CEUS showed nine cases of slender hepatic artery, six of hepatic arterial thrombosis that was confirmed by digital subtraction angiography and/or surgery, and one of hepatic arterial occlusion with formation of lateral branches. Among the two patients without portal vein flow at Doppler ultrasound, CEUS showed one case of hematoma compression and one of portal vein thrombosis,and both were confirmed by surgery. Among the 10 patients without bridging vein flow and with liver parenchyma inhomogeneous echo, CEUS showed regionally poor perfusion in the inhomogeneous area, two of which were confirmed by enhanced computed tomography （CT）, but no more additional information about bridging vein flow was provided by enhanced CT. CONCLUSION： CEUS may be a new approach for early diagnosis of postoperative vascular complications after RLDLT, and it can be performed at the bedside.     

Bile duct disease: prospective comparison of ERCP, CT, and fat suppression MRI.

The authors compared computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP), techniques commonly used to study the biliary tree, with pre- and post-Gd-DTPA breath-hold fast low angle shot (FLASH) and fat suppressed spin-echo in 28 consecutive patients with bile duct abnormalities detected on ERCP, including 11 patients with malignant disease and 17 patients with benign disease. ERCP, CT, and magnetic resonance (MR) images were prospectively interpreted in a blinded fashion and reviewed by consensus. ERCP characterized all cases of malignant disease by the presence of a narrowed bile duct lumen with irregular margins. CT and MRI detected all cases of malignant disease and characterized nine of 11 as malignant. In seven of these cases, CT and MRI showed thickening of extrahepatic bile duct walls greater than 5 mm. MRI images showed intrahepatic-enhancing periportal tissue in four cases, which was not seen on CT images, and which was biopsy-proven tumor extension. Benign disease was characterized on ERCP images by the demonstration of smooth tapered narrowings in 16 cases, whereas on CT and MR images it was characterized by mild to moderate dilatation of the intrahepatic bile ducts and wall thickness less than 5 mm in 13 cases. Overall ERCP correctly characterized 27 cases as benign or malignant and CT and MRI both characterized 25. The results of this study show a trend that ERCP is superior to CT and MRI for characterizing bile duct disease.     

全腹部薄层冠状面单次激发快速自旋回波序列MRI检查诊断小儿胆管疾病的价值分析

目的 探讨全腹部薄层冠状面单次激发快速自旋回波序列MRI在小儿肝内外胆管成像中的应用。方法 2014年10月~2016年9月收治的26例胆道系统疾病患儿（胆道闭锁症8例,胆道扩张症患儿14例,胆囊结石2例,胆管结石2例）,所有患儿均采取全腹部薄层冠状面单次激发快速自旋回波序列扫描,其中9例患儿在延迟15~20 min后采取MRI增强扫描。观察所有患儿的肝内外胆道和各级分支的解剖全貌,分析其走行分布和通畅情况等。结果 胆道闭锁症患儿肝内胆道均能够正常显示,而其中胆囊形态细小并且未见到肝外胆道显影者2例,肝外胆道和胆囊无显影6例。4例患儿肝脾肿大,2例患儿肝门区有三角形长T₂信号影;在胆道扩张症患儿中有11例患儿出现胆总管梭形扩张,有1例患儿表现为Caroli病,有2例患儿出现肝门区囊性包块,有4例患儿出现有胆囊增大和肝内胆道扩张;在胆系结石患儿中有3例患儿表现为胆总管局部管腔信号不均匀、短T₂信号的充盈缺损,胆囊结石患者表现为胆囊颈部短T₂信号的充盈缺损;与相同层面的扫描图像相比,延迟增强MRI扫描显示出肝脏、胰腺实质信号都有所减低,与胆胰管内长T₂信号的组织对比度则有所增加,其胆道系统显示更为清晰。结论 相对于常规腹部MRI扫描而言,全腹部薄层冠状面单次激发快速自旋回波序列能够更加细致地观察患者胆道系统解剖结构,更为全面地了解患者病变全貌和是否存在其他脏器异常,临床应用具有很大的诊断意义。