胆道癌栓与胆道结石的影象学特点分析

目的 探讨原发性肝癌或转移性肝癌所致的胆道癌栓与胆道结石在CT片、MRCP上的不同影象学特点。方法 60例患者均经ERCP检查证实为胆管结石或胆管癌栓，在此前提下，回顾性分析60例患者CT片、MRCP的影像学特点。结果男性36例，女性24例，胆管结石患者为40例（占66％），胆管癌栓患者为20例（占34％）。CT检查对胆管癌栓的符合率82．4％，对胆管结石的符合率88．6％，MRCP检查在胆管癌栓的诊断符合率为94％，对胆管结石的诊断符合率为96％。综合ERCP，CT，MRCP的影像学检查所见，胆道癌栓表现为有局部胆管膨胀性扩张，肝内胆管多呈“软藤症样扩张”表现，对胆管的阻塞可以是不完全性的，造影剂可以部分通过，胆管壁也较光滑，这与胆管癌时管腔的完全阻塞及胆管壁僵硬变形有所不同；往往无胆道结石的病史，肿瘤标志物显著升高，肝内或其他部位可查见肿瘤。而胆道结石无局部胆管膨胀性扩张，肝内胆管多呈“枯树枝样扩张”，易有胆道完全梗阻，往往有胆道结石的病史，肿瘤标志物无或轻度升高，扩张的胆管在取石后往往恢复正常；肝内或其他部位往往无肿瘤存在。结论 胆道癌栓与胆道结石的判断是结合病史、ERCP、CT片、MRCP片的综合判断，ERCP对表现不典型病例不仅能对病变进行诊断，且可以进行针对性治疗。

DIFFERENT IMAGING FEATURES BETWEEN CANCER EMBOLISM OF BILE DUCTS AND BILIARY CALCULI

Objective Explore the different features of CT and MRCP between the cancer embolism o bile ducts resulted of primary or metastatic liver cancer and biliary calculi. Methods Analyze CT and MRCP images of 60 patients Retrospectively which were proven as cancer embolism or biliary calculi by ERCP check. Results In these 60 patients,36 patients male and 24 female,40 cases（66% ） were biliary calculi and 20 cases （34%） were cancer embolism. The diagnostic confidence of CT scan was 82.4% for cnacer embolism and 88.6% for biliary calculi. The diagnostic confidence of MRCP check was 94% for cancer embolism and 96% for biliary calculi. Combining ERCP, CT and MRCP imaging, cancer embolism of bile ducts displayed of local expansion of bile ducts, ＂vine sign expansion＂ of intrahepatic bile duct,incomplete blockage of bile ducts. And radiopaque materials can pass through partly, the wall of bile vessel were smooth. The neoplasm can be found in liver usually. Billiary calculi displayed no local expansion of bile ducts, ＂dead tree branch sign expansion＂ of intrahepatic bile duct, and complete blockage of bile ducts. There were no neoplasm can be found in liver or other site. Conclusion To differentiate cancer embolism of bile ducts and biliary calculi, the patient＇s illness history, CT, MRCP and ERCP should be taken into consideration comprehensively. ERCP not only can make final diagnosis for untypical cases but also can treat them directly.