多层螺旋CT同层动态扫描结合MPR技术诊断肝外胆管癌的研究

目的探讨多层螺旋CT（MSCT）同层动态扫描技术诊断肝外胆管癌及胆管外浸润的价值，比较MSCT同层动态和MSCT多平面重组技术（MPR）对胆管癌病变性质及病变范围的诊断能力。方法39例患者行MSCT同层动态扫描，MSCTMPR在MSCT同层动态扫描后立即进行，在同层动态和MPR图像上分别评价病灶强化特征，评价两种方法对梗阻的病因及有无动脉、门静脉和肝脏浸润的诊断能力，并进行同层动态扫描和MPR检查对比。结果MSCT同层动态扫描诊断22例肝外胆管癌，MSCTMPR诊断18例肝外胆管癌，MSCT同层动态扫描与MSCTMPR诊断结果无显著差异；MSCT同层动态扫描对全部13例动脉、门静脉直接浸润均可诊断，MSCTMPR分别诊断5例动脉侵犯和9例门脉浸润，两者比较有显著差异。肝外胆管癌动脉侵犯在80S和120S显示13例，门脉侵犯在120S和200S显示13例，肝脏侵犯在120S和200S时显示全部5例，MSCT同层动态扫描各时间段之间差异有显著性。结论对肝外胆管癌梗阻的病因诊断，MSCT同层动态扫描不优于MSCTMPR；MSCT同层动态扫描对动脉、门静脉浸润显示能力高于MSCTMPR；肝外胆管癌动脉、门脉和肝脏侵犯分别在80-120s、120-200s及120-200s显示最佳。

Multislice CT in-layer dynamic scan combined MPR technique for diagnosis of extrahepatic cholangiocarcinoma

Objective To study the diagnostic values of multislice CT (MSCT) in-layer dynamic scan for the extrahepatic bile duct cholangiocarcinoma and their extraductal infiltration, and to compare diagnostic abilities of MSCT in-layer dynamic scan and MPR technique for range of cholangiocarcinoma. Methods Thirty-nine cases underwent both examinations of MSCT in-layer dynamic scan and MPR. All of them took MSCT MPR immediately after the MSCT in-layer dynamic scan, Focal enhancement features of images from both methods were analyzed. Disease causing obstruction was diagnosed. And situations of arterial, portal venous, and hepatic infiltration were also fully considered. Results of both techniques were finally compared and discussed. Results MSCT in-layer dynamic scan diagnosed out 22 cases of extrahepatic cholangiocarcinoma of 25 cases, MPR made definite diagnosis for 18 cases, there was no statistical differences between MSCT in-layer dynamic and MPR. MPR detected only 5 cases of arterial infiltration and 9 portal venous infiltrated ones of 13, MSCT in-layer dynamic detected all the cases. These were statistical differences between the two methods. Detected at 80 s and 120 s of dynamic scan, arterial infiltration was displayed in 13 cases. Portal venous infiltration of all 13 cases was displayed at 120 s and 200 s. Hepatic infiltration of all 5 cases was also displayed at 120 s and 200 s. Complemental injection of contrast media was given to all cases afterward, and their extraductal infiltation was all clearly displayed. Conclusion For detail disease diagnosis of extrahepatic bile duct obstruction, MSCT in-layer dynamic scan is no more applicable than MSCT MPR technique. But it is more advantageous to MPR for detection of arterial and portal venous infiltration. Arterial, portal venous, and hepatic infiltration of extrahepatic carcinoma are best displayed at 80-120 s, 120-200 s, and 120-200 s respectively.