胆囊癌侵犯胃肠道的螺旋CT诊断(附8例分析)

目的探讨胆囊癌侵犯胃肠道的螺旋CT表现，以提高对本病的认识。方法回顾性分析我院1998年儿月至2004年8月期间8例经手术和病理证实伴有胃肠道侵犯的胆囊癌患者的CT表现。8例均行CT平扫及增强双期扫描。并于扫描前饮入对比剂使上消化道充盈。结果8例中有2例胃窦受侵。6例十二指肠受侵，3例结肠肝曲受侵。术前CT诊断较为肯定的有2例胃窦和4例十二指肠受侵，表现为胆囊与受侵器官之间脂肪间隙不清、受侵处胃肠壁增厚、肿块形成、管腔狭窄等征象；对3例结肠肝曲受侵CT均不能肯定诊断。结论CT对判断胆囊癌是否侵犯胃和十二指肠有一定作用。但是对结肠肝曲受侵较难准确诊断。     

64排增强CT对进展期胃癌根治程度的判断价值

目的探讨64排增强CT(MDCT)对进展期胃癌(AGC)手术根治程度的判断价值。方法分析70例AGC患者MDCT增强扫描的影像学资料,判断N2(第7、8和9组)淋巴结转移及脏器受侵情况,并将CT判断结果与手术后病理结果进行比较。结果62例患者接受手术治疗,8例因手术禁忌证无法行手术治疗。MDCT术前判定N2淋巴结转移的敏感性为92.0%(46/50),特异性为75.0%(9/12),准确性为88.7%(55/62)。MDCT术前判定存在N2或以上淋巴结转移者81.6%(40/49)行D2以上扩大根治术;判定N2淋巴结无转移者92.3%(12/13)行标准D2根治术。结论MDCT对诊断AGC N2淋巴结转移及周围脏器侵犯有重要价值,对AGC手术根治程度的判定有指导作用。     

CT和MRI对中晚期胆囊癌周围脏器侵袭和转移的诊断价值

目的评价CT及MRI在中晚期胆囊癌周围脏器侵袭和转移中的诊断价值。方法回顾性分析我院2003年3月至2010年6月期间收治的经手术病理证实的中晚期胆囊癌患者45例,所有患者术前均同时行CT和MRI检查。结果①在诊断胆囊癌方面,CT诊断符合率为93.33%(42/45),MRI诊断符合率为88.89%(40/45),二者比较差异无统计学意义(χ2=0.287 2,P>0.05)。②在诊断胆囊癌转移的敏感度方面,肝脏直接浸润和转移诊断方面CT为72.00%(18/25),MRI为92.00%(23/25);胆管受侵诊断方面CT为83.33%(5/6),MRI为100%(6/6);胰腺转移诊断方面CT为100%(3/3),MRI为100%(3/3);淋巴结转移诊断方面CT为70.00%(7/10),MRI为90.00%(9/10);腹膜、网膜转移诊断方面CT为33.33%(1/3),MRI为33.33%(1/3)。诊断胆囊癌转移的总诊断符合率CT为72.34%(34/47),MRI为89.36%(42/47),MRI明显高于CT(χ2=4.083 3,P<0.05)。结论 MRI在诊断胆囊癌方面与CT相当,但在诊断肿瘤侵犯邻近器官及转移方面MRI略优于CT。     

多层螺旋CT在胆道恶性肿瘤诊断价值中的应用

目的评价多层螺旋CT诊断胆道恶性肿瘤临床效价并总结其影像学特点。方法收集整理2017年1月至2020年12月本院多层螺旋CT(Multidetector computed tomography,MDCT)诊断疑似胆道恶性肿瘤(Biliary tract carcinoma,BTC)病人影像学资料,以术后病理结果为标准,评价MDCT在BTC诊断中敏感性、特异性;分析总结确诊病例影像学特点。结果全组40例最终病理确诊为BTC31例(胆囊癌4例,肝内胆管癌14例,肝外胆管癌13例)。MDCT诊断BTC真阳性31例,假阳性2例,真阴性5例,假阴性2例。对应敏感度93.94%(31/33),特异性71.43%(5/7),阳性预测值93.94%(31/33)、阴性预测值71.43%(5/7)、总体符合率90%(36/40);BTC不同类型中,MDCT对于胆囊癌诊断效价分别为敏感性、特异性、总体符合率均为100%(4/4);对于肝内胆管诊断效价为敏感度敏感度87.5%(14/16),特异性50%(1/2)、总体符合率83.33%(15/18);对于肝外胆管诊断效价为敏感度92.85%(13/14),特异性75%(3/4),总体符合率88.89%(16/18)。结论 MDCT对BTC检测灵敏度和总体符合率较高,尤其是胆囊癌的诊断较为准确。在肝内胆管癌患者中,MDCT诊断的敏感度低于肝外胆管癌。     

螺旋CT三维重建技术在结直肠癌诊断中的应用价值

目的探讨8层螺旋CT三维重建在中晚期结直肠癌诊断中的应用价值。方法回顾分析43例经过手术证实的结直肠癌病例,术前均进行平扫和三期扫描和图像三维重建,将CT显示的影像特征与手术证实的结果进行对比分析。结果CT显示肿块准确率100.00%（43/43）,肿瘤浆膜层浸润诊断准确率94.59%（35/37）,淋巴结转移准确率76.92%（10/13）,远处脏器转移准确率61.54%（8/13）,显示供血血管准确率100.00%（24/24）。结论螺旋CT三维重建可以较好地显示病灶及病灶与周围脏器的关系,为外科手术治疗提供完整的信息。     

MSCT在直肠癌术前保肛评估中的应用

目的探讨MSCT在直肠癌术前保肛评估中的应用价值。方法对130例拟接受外科手术治疗的直肠癌患者于术前行MSCT平扫及三期动态增强扫描。术前评估可保肛的标准包括肿瘤下缘至肛提肌的距离≥1cm、直肠周围脏器未受侵、直肠周围无广泛淋巴结及癌结节转移。以手术结果为标准,评价MSCT直肠癌术前保肛评估的效能。并对MSCT术前评估与手术结果的一致性进行分析。结果 MSCT术前保肛评估的敏感度为94.12%(96/102),特异度为57.14%(16/28),准确率为86.15%(112/130),阳性预测值为88.89%(96/108),阴性预测值为72.73%(16/22)。MSCT术前评估与手术结果具有较好的一致性(Kappa=0.57,P0.05)。结论 MSCT直肠癌术前保肛评估具有较高的准确率。     

比较64排螺旋CT与超声扫查诊断闭合性腹腔脏器损伤的临床价值

目的分析比较64排螺旋CT平扫(CT平扫)与超声扫查诊断闭合性腹腔脏器损伤的临床价值。方法选取2015-09—2017-09间在平舆县人民医院接受手术治疗55例闭合性腹腔脏器损伤患者。术前均行腹部CT平扫和超声扫查。以术中所见为金标准,分析比较两种检查方法的诊断准确率。结果腹部CT平扫对腹腔实质性脏器及空腔脏器损伤的诊断准确率及总诊断率分别为92.3%(36/39)、87.5%(14/16)和90.9%(50/55),均高于超声扫查的84.6%(33/39)、75.0%(12/16)和81.8%(45/55)。差异均有统计学意义(P0.05)。结论 CT平扫对腹部创伤具有较高的诊断价值,其准确率较高,可迅速诊断出损伤脏器部位,为普外医生制订治疗方案提供重要的依据。     

CT检查在腹腔实质器官损伤中的临床价值

目的 探讨腹腔实质器官损伤中CT影像学表现的临床价值.方法 对外伤所致腹部脏器损伤的159例患者行平扫和(或)增强扫描,增强扫描采用动脉期、实质期,肾脏加做延迟期,与行增强扫描复查病例进行对比分析.结果 159例病例中,98例CT诊断为腹腔实质脏器挫裂伤,经手术与临床追踪得到证实,22例为单纯空腔脏器损伤或脊柱、骨盆骨折,39例为阴性,检查阳性率为75.5%(120/159),诊断符合率为98.1%(156/159).结论 CT检查能清楚显示实质脏器内损伤情况、包膜下血肿、腹膜后血肿、腹腔积液量,能对损伤的程度进行分级,正确选择扫描技术在腹部损伤诊断中有重要的临床价值.     

肝门胆管癌及邻近结构侵犯的MRI诊断价值

目的 探讨磁共振多序列成像诊断肝门胆管癌及邻近结构侵犯的价值.方法 采用T2WI横断面平扫、T1WI横断面平扫加增强扫描及冠状面增强扫描、真稳态自由进动快速成像序列冠状面扫描(true fast imaging with steady state procession,true FISP)、MRCP厚层T2加权成像、3D VIBE(volumetric interpolated breath-hold exalnination,VIBE)序列三期动态增强扫描,分析20例肝门胆管癌的大体类型及邻近结构侵犯情况,与手术及病理结果比较,评价术前扫描磁共振成像(magnetic resonance imaging,MRI)诊断价值.结果 ①肿块型7例,管壁浸润型11例,结节型2例,术前诊断准确率100%.②根据Bismuth-Corlette胆管受侵犯分型法,术前诊断准确率95%.③肝门血管受侵犯诊断准确率53.5%.④肝门淋巴结转移诊断准确率33.3%.结论 MRI在显示肝门部肿块大小、范围,沿胆管壁浸润方面,诊断价值较高;而显示血管侵犯及淋巴结转移方面诊断准确率较低.     

急诊腹部CT对于急性闭合性腹部损伤所致腹膜后血肿诊断价值的研究

目的探讨急诊腹部CT对于急性闭合性腹部损伤所致腹膜后血肿的诊断价值。方法回顾性分析本院收治的236例急性闭合性腹部损伤患者的临床资料,所有患者均行急诊腹部CT扫描,并于检查结束后进行急诊手术。以术中探查所见的实际情况为最终诊断的"金标准",评判CT扫描与术中实际情况的一致性,以及腹部CT扫描对于急性闭合性腹部损伤所致腹膜后血肿诊断的特异度、灵敏度、阳性预测值、阴性预测值和准确性,比较手术探查结果与CT扫描诊断具体情况。结果 (1)236例急性闭合性腹部损伤患者中,CT扫描诊断得出152例患者出现外伤后腹膜后血肿,占64.41%,手术探查确认有165例患者存在腹膜后血肿,占69.92%,经比较,CT扫描诊断与手术探查结果差异无统计学意义(P0.05);(2)CT扫描相对手术探查的灵敏度为89.70%,特异度为94.37%,经Kappa一致性检验,Kappa值为0.884,一致性最强;(3)手术探查结果与CT扫描诊断的具体情况差异无统计学意义(P0.05)。结论对于急性闭合性腹部损伤患者,在手术前进行急诊腹部CT扫描可以明确是否存在腹膜后血肿,其较高的准确率能够为临床医生提供有价值的参考。     

A preoperative assessment of adjacent organ invasion by stomach carcinoma with high resolution computed tomography

Adjacent organ invasion by stomach carcinoma on computed tomography (CT) was studied. CT images of tumors and their adjacent organs, whose invasion was assessed at surgery, were retrospectively analyzed in 51 gastric cancer patients. An absence of fat planes or an irregularity of the border between the tumor and adjacent organs was not found to be significantly related with invasion. The mean densities of the region of interest (ROI) set at the border were greater at the invasion sites (60.0±38.1) than at noninvasion sites (35.6±55.5) (P<0.05). The standard deviation of the densities in the ROI was not affected by invasion. The discriminant function determined invasion to the pancreas, liver, and colon with an accuracy of 75%, 61% and 78%, respectively. In diagnosing the invasion of stomach cancer on CT, the conventional criteria were not practical, while a quantitative analysis of the density in the ROI with high resolution CT was considered to improve the accuracy.     

超声造影诊断胆囊实性病变：与常规超声、增强CT/MRI对比

目的评价CEUS鉴别胆囊实性病变良恶性的价值,并与常规超声(US)、增强CT/MRI进行比较。方法回顾性分析49例胆囊实性病变患者的CEUS、US、增强CT/MRI资料,对比不同检查方法对良恶性病变的诊断效能。结果 49例中,胆囊癌32例,胆囊腺瘤局灶恶变2例,胆囊恶性黑色素瘤1例,胆泥3例,胆囊息肉8例,胆囊腺肌症1例,胆囊炎2例;恶性病变共35例,良性病变共14例。US、CEUS与增强CT/MRI诊断胆囊良恶性病变的准确率分别为71.43%、87.75%、89.80%。US与CEUS间(P=0.039)、US与增强CT/MRI间(P=0.020)诊断准确率差异均有统计学意义,CEUS与增强CT/MRI间诊断准确率差异无统计学意义(P=1.000)。不同检查方法间敏感度和特异度差异均无统计学意义(P均0.05)。结论 CEUS对良恶性病变诊断准确率优于US,与增强CT/MRI相近。     

Results of en bloc resection for hepatocellular carcinoma extending to adjacent organs

BackgroundTo curatively resect hepatocellular carcinoma (HCC) with adjacent organ extension, the combined resection of these organs is inevitable. We analyzed the safety and effectiveness of en bloc resection for HCC extending to adjacent organs.MethodsFrom December 2002 to May 2006, we compared the surgical outcomes of patients with HCC extending to adjacent organs with those of closely matched, randomly selected patients with HCC without adjacent organ extension.ResultsWe included 42 patients whose HCC extended to adjacent organs and 126 patients whose HCC did not extend to adjacent organs. There was no significant difference in survival, operative morbidity or mortality between the groups. In patients with HCC extending to adjacent organs, histopathological examination of the specimen revealed true tumour invasion in 13 and adhesion in 29 patients. Those with tumour invasion were more likely to have a high incidence of capsule infiltration, microvascular invasion and early intrahepatic recurrence (≤ 1 yr after hepatectomy). The 5-year overall survival of patients with tumour invasion was 11.5%, whereas that of patients with tumour adhesion was 38.1% (p = 0.033).ConclusionEn bloc resection is a safe and effective therapy for HCC extending to adjacent organs. Tumour invasion to adjacent organs exhibits a more aggressive clinical behaviour and is associated with worse survival than tumour adhesion.     

A case of xanthogranulomatous cholecystitis suspected to be adenocarcinoma based on the intraoperative peritoneal washing cytology

INTRODUCTION

Xanthogranulomatous cholecystitis (XGC) is a variant of chronic cholecystitis. XGC remains difficult to distinguish from gallbladder cancer radiologically and macroscopically.

PRESENTATION OF CASE

A 63-year-old female was referred to our hospital because of a gallbladder tumor. Abdominal CT and MRI revealed a thickened gallbladder that had an obscure border with the transverse colon. FDG-PET showed a high uptake of FDG in the gallbladder. Therefore, under the preoperative diagnosis of an advanced gallbladder cancer with invasion to the transverse colon, a laparotomy was performed. Because adenocarcinoma was suspected based on the intraoperative peritoneal washing cytology (IPWC), cholecystectomy and partial transverse colectomy were performed instead of radial surgery. However, the case was proven to be XGC with no malignant cells after the operation.

DISCUSSION

In patients with gallbladder cancer who underwent surgery in our institute from 2000 to 2009, the prognosis after the operation of patients with only positive IPWC tended to be better than that of patients with definitive peritoneal disseminated nodules. It is true that in some cases, it is difficult to differentiate XGC from gallbladder carcinoma pre- and intra-operatively.

CONCLUSION

Surgical procedures should be selected based on the facts that there are long-term survivors with gallbladder cancer diagnosed with positive IPWC, and that some patients with XGC are initially diagnosed to have carcinoma by IPWC, as was seen in our case.     

Rapid recurrence of spindle cell type undifferentiated carcinoma early after radical surgery in a bile duct cancer patient – A case report

IntroductionSpindle cell type undifferentiated carcinoma of the extrahepatic bile duct is extremely rare and has a poor prognosis. However, its pathology is not fully known, yet.Case presentation76-year-old man with abdominal pain and dark-colored urine was referred to our department. Contrast-enhanced computed tomography showed an enhanced tumor at the junction of the cystic duct and direct invasion of the portal vein. He was diagnosed as having resectable biliary cancer and underwent a subtotal stomach-preserving pancreaticoduodenectomy with a reconstruction of the portal vein. Histopathological findings demonstrated undifferentiated spindle cell carcinoma. Forty-two days post-surgery, he presented with peritoneal dissemination and local recurrence with ascites, and died sixty-five days after his operation.Clinical discussionSpindle cell type undifferentiated carcinoma has highly metastatic potentials and also easily invade adjacent organs. Therefore, the prognosis of an undifferentiated, spindle cell type cholangiocarcinoma was poor. Although only surgery ensures cure, multidisciplinary treatment, including chemotherapy and radiotherapy is required.ConclusionAlthough surgery for spindle cell type undifferentiated carcinoma may provide a cure, we must consider the induction of multidisciplinary treatment.     

ԭ���Ե��Ұ�Ӱ��ѧ����������

??Imageology features and assessment of gallbladder carcinoma HUANG Sui-qiao. Department of Radiation, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China
Abstract There are many imaging methods in detecting gallbladder carcinoma. Ultrasonography is the most common imaging method now, but the applications of CT and MRI are increased gradually and shown very important in diagnosing gallbladder carcinoma in clinical practice. 18F-FDG PET-CT has very high specificity and can be used in diagnosing difficult cases. It is not difficult for diagnosing typical gallbladder carcinoma, but it is not easy to diagnose early stage of gallbladder carcinoma. The applications of CDFI, contrast-enhanced ultrasound, dynamic CT and MRI scanning, DWIBS technique and 18F-FDG PET-CT will hopefully increase correct diagnosing level for early stage of gallbladder carcinoma. CT and MRI are better in demonstrating invasion of near structures and lymph node involvement due to gallbladder carcinoma. But lymph node involvement can easily get missed diagnosis just based on the size of lymph node. The shortages would be improved by 18F-FDG PET-CT and DWIBS technique.     

原发性胆囊癌的CT诊断

作者报道了经手术病理证实的原发性胆囊癌１５例，其中肿块型２例，壁厚型８例，腔内型２例，混合型３例，伴有直接侵蚀肝脏的９例，胆管扩张的９例，区域性淋巴结增大１３例。文中就ＣＴ对胆囊癌的诊断价值和鉴别诊断进行了讨论。     

原发性肝癌肝动脉灌注栓塞术后肿瘤存活区的血液供应

目的采用多层螺旋CT(MSCT)平扫及增强双期扫描,研究原发性肝癌(HCC)经肝动脉灌注碘化油栓塞术(LPTACE)后肿瘤存活区(VTA)的血液供应,以期对再治疗方案和途径的选择提供有价值的信息。方法38例HCC患者共55个病灶,经57次LPTACE后行MSCT平扫及增强双期扫描,根据增强扫描不同时期的强化表现,将VTA的血液供应分为四种类型:肝动脉供血型、门静脉供血型、双重供血型及少血供型;统计各种血供类型的比例,并与术前肿瘤血供进行比较。结果38例患者行57次LPTACE后的肿瘤存活区在平扫表现为肿瘤内栓塞碘化油之间及周围非坏死低密度影,其CT值为(37.71±7.78)Hu。低密度肿瘤存活区有四种类型的血液供应,分别为:肝动脉供血型(29例)、门静脉供血型(2例)、双重供血型(22例)、少血供型(4例)。与术前肿瘤血供比较,门静脉参与供血有增加。结论HCC经LPTACE术后肿瘤存活区血供以肝动脉供血和肝动脉、门静脉双重供血为主,单纯门静脉供血及少血供较少。与LPTACE术前相比,门静脉对肿瘤存活区的供血有增加。     

Triple cancer of gallbladder,common bile duct and papilla of Vater: Report of a case and review of literature

Introduction and importanceSynchronous malignancies of gallbladder and biliary tree are together rare entity whose pathogenesis is yet unknown. We report the case of a triple synchronous cancer of 3 distinct location: gallbladder, common bile duct (CBD) and papilla of Vater.Case presentationAn 84-years-old woman, was admitted to our Hospital with clinics features of obstructive jaundice.Dilatation of the biliary tree and CBD without evidence of gallstones was seen at US. CT scan confirmed distal CBD obstruction.An endo-US showed a nodule of the head of pancreas infiltrating the lower CBD.Finally, hepatic-MRI displayed a gallbladder malignancy with invasion of CBD.Preoperative staging showed 3 diagnostic suspicions: carcinoma of CBD on CT, pancreatic carcinoma on endo-US and malignancy of gallbladder on MRI.A cephalic duodenopancreatectomy and radical gallbladder resection was performed.Final pathology revealed 3 distinct location of moderately differentiated adenocarcinomas: Gallbladder, CBD and Vater's papilla.Microscopic examination didn't detect any direct continuity between the 3 tumors. Metastases were identified in the pancreaticoduodenal, peri-hepatic and peri-gastric lymph nodes.Clinical discussionLiterature displayed 22 cases of synchronous malignancies of gallbladder and CBD and 1 case of triple cancer with associated Vater's papilla carcinoma.In most of these cases, an association with an anomalous pancreatic-bile duct junction was reported.Although the real incidence remain unknown, it was reported to occur in 5–10% of CBD cancers.ConclusionSuspicion of such combination of cancer should be remembered, especially when preoperative investigations don't allow a precise localization of tumor in the biliary tree.