多层螺旋CT在肝外胆管梗阻病变诊断中的应用

目的：探讨多层螺旋CT（MSCT）在肝外胆管梗阻病变中的应用价值。方法回顾性分析经手术、病理以及临床随访证实的均做了CT检查的肝外胆管梗阻病变51例,其中良性41例,恶性10例。结果肝外胆管梗阻性病变中,良性多表现为肝内胆管呈枯枝状或残根状轻、中度扩张,梗阻部胆管呈漏斗样改变,肝外胆管壁呈环形弥漫性增厚;恶性多表现为肝内胆管呈软藤状中、重度扩张,梗阻部胆管呈截断型或突然狭窄并伴肿块,肝外胆管壁呈环形局限性增厚。结论良恶性肝外胆管梗阻病变均有其特征性的CT征象,注意观察胆管的形态改变,以及与周围组织结构的关系,结合临床综合分析,有助于提高诊断的准确性。     

胆道阻塞的CT诊断—与直接胆管造影的比较研究

本文对８２例手术病理证实的阻塞性黄疸作前瞻性ＣＴ诊断，并与直接胆道造影比较研究。发现胆管逐渐尖削，明显的肝外胆管壁环状增厚是良性阻塞可靠且特异的ＣＴ征象。肝内外胆管不一致扩张（内轻外重），扩张胆管腔内ＣＴ值大于２０ＨＵ对良性阻塞的判断有一定帮助。管突断伴或不伴肿块，胆管壁局根不规则增厚是恶性阻塞相对可靠且特异的ＣＴ征象。ＣＴ能清楚显示肝内胆管扩张及它们汇合处解部剖及变异。比较直接胆管造影，ＣＴ对肝     

螺旋CT扫描对低位性胆道梗阻的诊断价值

目的：分析低位胆道梗阻的备种CT表现．总结出具有定性诊断意义及鉴别诊断意义的CT征象。材料与方法：回顾分析经手术和病理证实，术前均做螺旋CT扫描的低位胆道梗阻病例106例，良性组59例，恶性组47例。扫描方式分为平扫和双期增强扫描，观察胆总管及胰管的梗阻和扩张情况。结果：直接征象：梗阻部位见高密度结石32例，由CT增强扫描辨出等、低密度结石13例；梗阻平面发现肿块42例，其中良性5例，均为慢性胰腺炎，其余为恶性。间接征象：梗阻平面以上胆、胰管扩张，胆囊增大。良性梗阻者肝内胆管及胰管多呈轻、中度扩张；胆总管壁轻度增厚，扩张的胆总管自上向下渐进性狭窄。恶性梗阻者肝内胆管多呈中、重度扩张(藤样扩张)，胰管扩张明显；梗阻部位肿块边界不清、扩张的胆总管突然截断。结论：低位性胆道梗阻良、恶性病变各有不同的特征性CT表现，螺旋CT平扫及双期增强扫描、梗阻部位薄层扫描的合理运用，对低位性胆道梗阻的发现和病因诊断、鉴别诊断具有十分重要的价值。     

胆道扩张的形态学MR表现对胆道梗阻性病变的诊断分析

目的根据胆道扩张的形态学的影像表现对不同胆道梗阻性病变进行分析,判断其原发病灶的性质。方法收集我院2014年1月~2016年3月共计95例梗阻性黄疸患者,行磁共振成像及磁共振胰胆管造影(MRCP)检查,所有患者进行手术或逆行胰胆管造影(ERCP)检查获得病理结果。根据所有患者的影像学资料分析其肝内胆管扩张的程度、形态,肝外胆管扩张末端变化,梗阻部位及原发病性质。结果良性梗阻多为轻度胆管扩张,呈枯枝状;即使中度扩张也极少呈软藤状,而较多呈残根状。恶性梗阻多为中、重度胆管扩张,且多呈软藤状;高、中位胆道梗阻多见于恶性病变,低位胆道梗阻良性与恶性病变发生的比例相近;恶性梗阻扩张肝外胆管末端突然中断,良性梗阻扩张肝外胆管末端逐渐变细。结论磁共振胰胆管成像对良、恶性胆道梗阻病病变具有较高的诊断价值,分析胆道扩张的形态特征,对鉴别良、恶性梗阻病变有较大意义,有利于指导临床治疗。     

MRI及MRCP在肝门胆管癌和肝门部良性胆道梗阻中的鉴别价值

目的 探讨肝门胆管癌和肝门部良性胆道梗阻的MRI、MRCP鉴别诊断价值.方法 回顾性分析经手术病理或临床证实的13例肝门胆管癌和20例肝门部良性胆道梗阻的MRI、MRCP表现,并与临床手术、病理进行对照.结果 13例肝门胆管癌中显示浸润型9例,T2 WI显示管壁增厚;肿块型4例,肝门部显示类圆形结节,T1WI呈稍低信号,T2 WI呈稍高信号.MRCP显示肝门胆管梗阻端的形态特征,截断状5例(肝门区呈空虚状改变),鼠尾状8例.肝内胆管呈树枝状和软藤状扩张.20例肝门部良性胆道狭窄的病例中,胆管结石13例,肝门部胆管炎症2例,术后狭窄5例.左肝管狭窄4例,右肝管狭窄1例,汇合部狭窄5例,肝总管狭窄10例(包括Mirizzi综合征4例),肝门区均未见软组织结节.MRCP显示肝门区胆管不完全性梗阻,呈漏斗状狭窄,边缘光滑.肝内胆管呈枯枝状扩张3例,树枝状扩张17例.结论 常规MRI和MRCP结合有助于肝门部胆道梗阻的定位诊断.肝门胆管癌和肝门部良性胆道梗阻在MRI、MRCP上存在多种不同征象可鉴别诊断.     

恶性梗阻性黄疸的ERCP与CT对照分析

本文对比分析了８２例恶性梗阻性黄疸（包括胆管癌４５例，转移性癌２６例，胰头癌６例及壶腹周围癌５例）的ＥＲＣＰ与ＣＴ表现，主要发现：恶性胆管梗阻部位多位于肝外胆管近侧段；肝外胆管近侧段梗阻所致的肝内胆管重度扩张的发生率，远多于远侧段阻塞，在反映肝内胆管扩张程度、扩张范围方面ＣＴ优于ＥＲＣＰ，而显示病灶肿块直接征象方面ＥＲＣＰ优于ＣＴ。     

原发性十二指肠腺癌MSCT表现

_目的：探讨原发性十二指肠腺癌 MSCT 三期增强扫描的影像学特征,总结分析其误诊、漏诊原因。方法：回顾性分析21例经病理证实的十二指肠腺癌的临床、病理及 CT 表现特征。结果：21例十二指肠腺癌中14例呈肿块型,表现为腔内息肉状或菜花状软组织肿块,边界清晰,多呈轻中度均匀强化;6例呈缩窄型,表现为肠壁不规则或环形增厚,肠腔狭窄,常伴有近段肠管扩张,边界清楚或毛糙,可突破浆膜面,呈中度或重度均匀、不均匀强化;1例因图像质量差难以评价。累及十二指肠乳头部的腺癌常伴有肝内外胆管、胰管扩张。21例十二指肠腺癌中正确诊断13例,3例误诊为十二指肠腺瘤,1例误诊为胰头癌,2例误诊为壶腹癌。2例因 CT 检查仅表现为肝内胆管轻度扩张而漏诊。1例肝内转移灶漏诊。结论：MSCT 对十二指肠腺癌的诊断具有重要价值,保证十二指肠的充盈、重视门脉期对肝转移灶的检出以及肝内胆管轻度扩张这一间接征象,有助于更好地发现病变,降低误诊、漏诊率。     

恶性梗阻性黄疸的ERC写CT对照分析

本文对比分析了８２例恶性梗阻性黄疸（包括胆管癌４５例，转移性癌２６例，胰头癌６例及壶腹周围癌５例）的ＥＲＣＰ与ＣＴ表现，主要发现：恶怀胆管梗阻部位多位于肝外胆管近侧段；肝外胆管近侧段梗阻所致的肝内胆管重度扩张的发生率，远多于远侧段阻塞，在反映肝内胆管扩张程度、扩张范围方面ＣＴ优于ＥＲＣＰ，而显示病灶肿块直接征象方面ＥＲＣＰ优于ＣＴ。     

肝门部胆管癌的多层螺旋CT诊断

目的：评价MSCT对肝门部胆管癌的诊断价值。方法：回顾性分析17例行MSCT平扫及动态增强扫描的肝门部胆管癌影像学资料,并与手术及病理对照分析。结果：全部病例均有肝内外胆管扩张,肝内胆管扩张呈软藤状。胆管内肿块（5例）,胆管壁局限增厚和管腔狭窄（12例）,平扫均为等密度。增强扫描3例强化,14例延迟强化。结论：胆管壁局限增厚、胆管内肿块是肝门部胆管癌的较特征性CT征象,MSCT扫描结合薄层三维重建对诊断具有重要意义。     

CT在诊断胆道梗阻中的价值分析

目的 探讨CT在诊断阻塞性黄疸中的价值。方法 对80例梗阻性黄疸患者均行CT平扫和增强扫描,对梗阻端邻近胆管进行薄层扫描,检查后由放射科医师做定位及定性诊断,并结合手术病理结果对照分析。结果 胆总管环形征(定位率98.8％);梗阻端形态:尖削状(良性率100％),突然截断(恶性率81％);邻近胆管壁情况:环形增厚(良性率97％),不规则增厚(恶性率100％);邻近胆管内CT值:>20Hu(结石100%),<20Hu(恶性率74.5%);肝内外胆管扩张情况:一致(恶性率74％),内轻外重(良性率89％);伴肿块(恶性率85.6％);此组CT定性诊断率90％。结论 梗阻性黄疸各种CT表现在诊断方面都存在一定特异性或敏感性,应综合判断。     

Computed tomographic diagnosis of obstructive jaundice in the absence of intrahepatic ductal dilatation.

Six patients with obstructive jaundice had computed tomography (CT) scans showing a dilated extrahepatic biliary tree in the absence of intrahepatic ductal dilatation. Dilated extrahepatic bile ducts were most easily identified by means of intravenous injection of urographic contrast material, which permitted them to be seen as low density structures. Findings in these patients emphasize that (1) demonstration of dilated intrahepatic bile ducts is not a prerequisite for the CT diagnosis of obstructive jaundice and (2) careful CT evaluation of the extrahepatic biliary tree is necessary to identify patients with isolated dilatation of the common hepatic or common bile duct.     

Patterns of intrahepatic bile duct dilatation at CT: correlation with obstructive disease processes.

The authors performed a blinded, retrospective analysis of 100 computed tomographic (CT) scans of patients with proved extrahepatic bile duct obstruction, including primary sclerosing cholangitis (PSC), to determine whether certain patterns of intrahepatic bile duct dilatation are suggestive of specific disease processes. Among 30 patients with benign obstructive disease, CT showed pruning of the intrahepatic ducts in four patients (13%), beading in four (13%), and skip dilatations in one (3%). Among 54 patients with malignant obstructive disease, CT illustrated pruning in eight (15%) patients, beading in 11 (20%), and skip dilatations in two (4%). Among 16 patients with PSC, CT demonstrated pruning in four (25%), beading in two (13%), and skip dilatations in five (31%). The majority of patients with malignant or benign obstructive disease or PSC had intrahepatic duct dilatation in both lobes of the liver. It extended into the periphery in 46 of 54 patients (85%) with malignant obstructive disease, in 20 of 30 (67%) with benign obstructive disease, and in 10 of 16 (63%) with PSC. The CT finding of skip dilatations is strongly suggestive of PSC. The CT findings of pruning and beading are nonspecific and may be observed at CT in patients with bile duct obstruction due to a wide variety of causes. The distribution and extent of intrahepatic duct dilatation at CT do not differ among biliary disease processes.     

CT findings of clonorchiasis

Clonorchiasis is a snail-transmitted trematodiasis caused by Chinese liver fluke, Clonorchis sinensis. Forty-two patients with the disease were examined with CT. Seventeen patients had clonorchiasis alone, and 25 patients had clonorchiasis with hepatobiliary malignancies (20 cholangiocarcinomas, four hepatocellular carcinomas, one carcinoma of the ampulla of Vater). In three of the 17 patients with clonorchiasis alone, the CT scans were normal. In 14 patients (82%), CT showed diffuse, minimal, or mild dilatation of the intrahepatic bile ducts. None of the patients had marked dilatation. The extrahepatic biliary tree was normal in all 17 patients. All 25 patients with clonorchiasis and hepatobiliary malignancies had diffuse dilatation of the intrahepatic bile ducts on CT, including 18 patients with minimal or mild dilatation and seven patients with marked dilatation. All seven patients with marked dilatation had extrahepatic biliary malignancies. Clonorchis sinensis per se or thickening of the bile duct wall could not be recognized on CT scans. Additional abnormalities evident on CT included pyogenic liver abscesses in two patients and gallstones in five patients. The diagnosis of clonorchiasis can be suspected when CT shows diffuse, uniform, and minimal or mild dilatation of the intrahepatic bile ducts, particularly in the periphery of the liver, without evidence of extrahepatic biliary dilatation.     

Diagnostic and interventional procedures for the biliary tract

Various diagnostic imaging studies have been employed in the past year to evaluate the normal and abnormal biliary ductal system. Variations in the normal ductal drainage of the left lobe of the liver, in which the right lateral hepatic duct drained into the left hepatic duct, were studied because of the implications for the surgical resection of the left lobe. Choledochal cysts have been studied in adults using endoscopic retrograde cholangiopancreatography to evaluate the abnormal junction between the common bile duct and pancreatic duct and the long dilated common channel. An ultrasound study indicated that children with choledochal cysts also may have intrahepatic duct dilatation. An increased incidence of malignancy has been noted in adults with choledochal cysts, and their appearance on ultrasound, CT, and cholangiography were described. Cystic fibrosis produces abnormalities of the biliary tree, extrahepatic strictures, and more interestingly, intrahepatic ductal dilatation and abnormal contour without strictures. The usefulness of the preoperative ultrasonographic evaluation of the biliary tract in Oriental cholangiohepatitis was stressed. Bile duct abnormalities in fascioliasis were also noted on CT scans. Patterns of abnormality in the CT appearance of the thickened, contrast-enhanced, extrahepatic bile ducts were elucidated. Focal concentric, focal excentric, diffuse concentric, and diffuse excentric ducts were seen with various forms of pancreatic disease, choledocholithiasis, and various forms of cholangitis. An enhanced, thick-walled duct indicates disease, but is a nonspecific finding. Chronic cholecystitis was found to produce false-positive cholescintigram results in patients with suspected acute cholecystitis, but only in those with severe degrees of chronic cholecystitis. The results of multicenter trials using extracorporeal biliary lithotripsy in the United States have been published. They are somewhat disappointing and do not confirm the original excellent results reported in Germany for treatment of gallbladder stones. Much interest has been focused on the use of expandable metallic stents for the treatment of benign and malignant biliary obstruction. Preliminary data suggest good patency rates for benign lesions. Patency rates for malignant lesions are similar to those of previously available plastic stents.     

16层螺旋CT曲面重建在诊断胆总管扩张疾病中的应用

目的评价16层螺旋CT曲面重建对诊断胆总管扩张病变的应用价值。方法 51例经手术及其中43例又经病理证实的胆总管扩张患者,包括34例恶性病变（14例胆总管癌,11例胰腺癌,9例肝癌或肝转移瘤）和17例良性病变（8例胆总管结石,4例胆总管炎性狭窄,3例胆囊切除术后,2例胰腺炎）均经16层螺旋CT腹部平扫,随后将源像传送至工作站进行后处理曲面重建（CPR）。结果 CPR能直接全程显示扩张的胆总管,准确判断其梗阻部位、范围、形态以及与邻近解剖结构的关系,并能鉴别良恶性病变的CT征象,例如,胆总管癌表现为胆总管中段管腔内结节影和肝内、外胆管重度扩张,而胰腺炎合并胆总管结石表现为胆总管与胆囊扩张,横轴位像显示胆总管胰头处结节状结石影。结论 CPR在诊断胆总管扩张及鉴别其良恶性病变中起重要作用,它应作为诊断本病的首选方案。     

对肝外胆管梗阻时“软藤征”的再认识

本文回顾性分析了48例“软藤征”的病因,其中恶性疾病28例(占58.3％),良性疾病20例(占41.7％)。据本文资料,作者认为“软藤征”是肝管分叉部及肝外胆管急性完全(或接近完全)性梗阻时肝内胆管扩张的特征性X线表现,并非恶性梗阻特有,良性梗阻亦常见。作者指出,只要肝内胆管无或仅有轻度炎症,胆管具有良好的弹性和扩张性,不论良、恶性病变都可出现“软藤征”。那种认为当梗阻病变未显示时,仅根据“软藤征”即可作出恶性梗阻诊断的观点很值得商榷。作者认为,“软藤征”的定性及病因诊断主要应根据PTC或ERCP,或二者联合显示梗阻局部病变的形态学特征来确定。     

Cholangiopathy in extrahepatic portal venous obstruction. Radiological appearances

PURPOSE: To evaluate cholangiographic abnormalities resulting from extrahepatic portal venous obstruction (EHPVO) by sonography and endoscopic retrograde cholangiopancreaticography (ERCP). MATERIAL AND METHODS: Forty-three patients with an established diagnosis of EHPVO were subjected to duplex Doppler sonography and ERCP. Of these, 8 patients had obstructive jaundice. RESULTS: Dilated common bile duct with pericholedochal varices showing a continuous type of flow pattern was seen in 5 EHPVO patients with obstructive jaundice. ERCP revealed cholangiographic abnormalities in 40 patients (93%). Extrahepatic bile ducts were involved in 100% of cases compared to intrahepatic bile ducts (57%). Abnormalities noted were contour irregularity with indentations, displacement and angulation, strictures and filling defects in the extrahepatic ductal system. Intrahepatic bile ducts showed dilatation with areas of narrowing and filling defects. CONCLUSION: Cholangiographic abnormalities are very common in patients with EHPVO, even without clinical manifestations of biliary disease. Extrahepatic bile ducts are far more often involved compared to intrahepatic bile ducts. Extrinsic compression with contour irregularity is the most common cholangiographic finding. Sonographic findings are not diagnostic. Dilated common bile duct with pericholedochal varices was seen in only 5 patients.