胆管癌46例CT诊断分析

目的 探讨胆管癌患者的CT诊断.方法 回顾性分析46例经手术、经皮穿刺活检并病理证实的胆管癌患者的资料,总结其CT平扫及动态增强表现.结果 12例肝内胆管癌CT平扫表现为类圆形、不规则形的低密度肿块,肝内胆管扩张66.7%(8/12),肝叶萎缩41.7%(5/12),增强扫描动脉期肿瘤周边轻度强化;延迟扫描随时间延长,病灶逐步强化,尤其9min后,所有病灶均高于正常肝实质密度.肝门部胆管癌24例均显示肝内胆管扩张,形态呈"软藤样",21例显示肝门区软组织肿块,另3例仅显示胆管壁增厚、狭窄或中断,可合并肝门淋巴结、后腹膜淋巴结、网膜转移及腹水.肝外胆管癌10例肝内外胆管扩张、胆囊增大、胆总管突然截断或胆总管不规则狭窄.结论 CT可较清晰的显示胆管癌病变、胆管扩张程度及对周围浸润范围,对早期发现胆管癌价值较大.

CT diagnosis of the carcinoma of bile duct: an analysis of 46 cases

Objective To investigate the CT diagnosis of patients with the carcinoma of bile duct. Methods The data of 46 patients who were treated with surgery, percutaneous puncture biopsy and pathologically confirmed to have the carcinoma of bile duct were collected, and the manifestations of CT plain scanning and dynamic enhancement scanning were retrospectively analyzed. Results The liver CT plain scanning of the carcinoma of intrahepatic bile duct was manifested as similar round and irregular low-density tumor, intrahepatic cholangiectasis was observed in 66.7%, and atrophy of liver lobe was observed in 41.7%; the enhancement scanning was manifested as mild enhancement of peripheral tumor at the arterial phase. The delayed scanning showed that as time elongated, the focus became enhanced gradually, especially that after 9 minutes, the intensities of all the loci were higher than those of normal liver parenchyma. The carcinoma of bile duct at hilus hepatis all displayed as intrahepatic cholangiectasis, and the forms appeared as "soft vine". 21 patients were displayed as soft tissue tumors of hepatic hilar region. Another 3 patients were only displayed as the thickening, stenosis or discontinuation of bile duct wall, and could be accompanied by portal lymph node, the lymph node of posterior abdominal membrane, epoploon metastasis and abdominal dropsy. The carcinoma of extrahepatic biliary duct was manifested as intrahepatic and extrahepatic cholangiectasis, the augmentation of cholecyst, the sudden desection of common bile duct or irregular stenosis of common bile duct. Conclusion CT can clearly display the lesion of the carcinoma of bile duct, the degree of cholangiectasis, and the range of surrounding infiltration, and CT is very significant in detecting the carcinoma of bile duct at early period.