原发性十二指肠恶性肿瘤的影像学诊断

目的 探讨X线、CT及血管造影对原发性十二指肠恶性肿瘤的诊断价值及鉴别诊断。资料与方法 回顾分析经手术和／或病理证实的46例原发性十二指肠恶性肿瘤的l临床及影像学资料，46例全部作过十二指肠气钡双对比造影，并有13例作低张十二指肠插管造影；28例作CT检查；11例作数字减影血管造影。结果 胃十二指肠双对比造影及低张十二指肠插管诊断十二指肠癌24例；平滑肌肉瘤6例；恶性淋巴瘤4例。诊断总符合率为73．91％(34／46)。误诊率为17．39％(8／46)，漏诊率为8．7％(4／46)。CT检查28例，确诊十二指肠癌4例，平滑肌肉瘤7例。误诊为腹腔脓肿2例，平滑肌瘤6例，腹腔恶性肿瘤9例。诊断符合率为39．29％(11／28)，误诊率为60．71％(17／28)。血管造影11例，9例检出病变，6例确诊为十二指肠恶性肿瘤，3例误为良性肿瘤，2例未发现明显肿瘤血管。确诊率为54．55％(6／11)，误、漏诊率分别为27．27％(3／11)、18．18％(2／11)。结论 胃十二指肠气钡双对比造影是发现十二指肠恶性肿瘤最简单易行的方法，它和胃镜配合能得到病理学诊断。低张十二指肠插管造影对重度肠腔狭窄或阻塞患者显示病变范围起补充作用。CT能显示管外型恶性肿瘤的软组织块影及管壁破坏和有无淋巴结肿大。血管造影能根据血供来源明确钡餐难发现、CT仅显示与肠管无明显联系的平滑肌肉瘤，并可进行栓塞IE血治疗。

Imaging Diagnosis of Primary Duodenal Malignancy

Objective To evaluate radiography, CT and angiography in the diagnosis and differentiation of primary duodenal malignancy.Materials and Methods Both clinical data and imaging findings in 46 patients with surgically- or pathologically-proved primary duodenal malignancy were retrospectively analyzed. The imaging materials included air-barium double-contrast gastroduodenal radiography (n=46), hypotonic duodenal intubation radiography (n=13), CT scan (n=28) and digital subtracted angiography (DSA, n=11).Results With double contrast GI and hypotonic duodenal radiography, duodenal cancer was diagnosed in 24 cases, leiomyosarcoma in 6 cases and malignant lymphoma in 4 cases, with a total diagnostic agreement of 73.91% (34/46), misdiagnosis of 17.39% (8/46) and mist diagnosis of 8.7% (4/46). CT scan confirmed duodenal cancer in 4 cases, leiomyosarcoma in 7 cases, with an accuracy of 39.29% (11/28). On CT, 2 cases were misdiagnosed as abdominal abscess, 6 cases as leiomyoma and 9 cases as abdominal malignancy, with a misdiagnosis rate of 60.71% (17/28). On DSA, duodenal malignancy was confirmed in 6, benign lesion in 3 and no obvious abnormality in 2, with diagnostic accuracy of 54.55% (6/11), misdiagnosis of 27.27% (3/11) and mist diagnosis of 18.18% (2/11).Conclusion Double contrast GI exam is the most simple and effective exam for detecting duodenal malignancy. Gastroscopy can obtain pathologic information. Hypotonic duodenal intubation radiography is a supplement exam for revealing the lesion's extent in the patients who has severe intestinal stricture or obstruction. CT can demonstrate the soft tissue mass of intestinal extra-cavity malignancy, destruction of intestinal wall and the lymphadenopathy. DSA can reveal the leiomyosarcoma, which is hard to be detected by GI study and which shows no obvious relation to the intestinal canal, more over, embolization therapy can be carried out at the same procedure.