肝门区胆管细胞癌的多层螺旋CT 表现

杨立 杨州 赵绍宏 聂永康 应逸凤 赵红 方捷 蔡祖龙
【摘要】 目的 探讨肝门区胆管细胞癌直接征象的多层螺旋CT( MSCT) 表现。方法 应用
MSCT 对19 例无痛性黄疸患者行上腹部常规平扫及静脉注射对比剂后25 和60 s 双期增强扫描,
15 例应用增强扫描数据行三维图像重组, 以3 级评分法, 判断MSCT 对肝门区胆管细胞癌直接征象的
显示能力。分析病变胆管的形态学特征、胆管受累范围。19 例均经手术病理( 15 例) 或内镜逆行胰
胆管造影( ERCP, 4 例) 证实为胆管细胞癌。结果 15 例行三维图像重组者有14 例显示肿瘤直接征
象和肿瘤累及范围, 19 例行25 和60 s 双期增强扫描者分别有8 例和7 例显示肿瘤直接征象和肿瘤
累及范围, 三者间差异具有统计学意义( P 值均< 0. 05 ) 。注药25 s 时肿瘤强化最明显, 表现为肝总
管管壁环行增强、增厚、管腔局部狭窄或完全闭塞, 三维图像呈模拟染色体样表现, 并可观察到病变
远、近端胆管内播散结节。结论 MSCT 在注射对比剂后25 s 扫描, 病变增强最明显; 三维重组图像
可观察胆管的直接征象和受累范围。
【关键词】 胆管肿瘤; 体层摄影术, X 线计算机; 成像, 三维
Multislice helical CT in the diagnosis of hilar cholangioca rcinoma YANG Li* , YANG Zhou, ZHAO
Shao-hong, NIE Yong-kang, YING Yi-feng, ZHAO Hong, FANG J ie, CAI Zu-long. * Department of
Radiology, PLA Genera l Hospita l, Beijing 100853, China
【Abstra ct 】 Obj ective To investigate the value of MSCT in observing the direct findings of hilar
cholangiocarcinoma. Methods Multislice helical CT studies were performed on the upper abdomen in
19 consecutive patients with painless jaundice. Precontrast and dynamic contrast enhanced ( 25 s phase and
60 s phase) scans were conducted, and 3D images were reconstructed using enhanced raw data in 15 cases.
The direct CT findings of hilar cholangiocarcinoma were studied by three radiologists respectively in a 3-scale
strategy. The morphological features and extension of bile duct involvement by hilar cholangiocarcinoma were
analyzed. All the 19 cases were pathologically proved as hilar cholangiocarcinoma by surgery ( 15 cases) and
ERCP ( 4 cases ) . Results The direct findings and extension of hilar cholangiocarcinoma could be
demonstrated in 14 out of 15 3D reconstruction images, 8 out of 19 in 25 s phase, and 7 out of 19 in 60 s
phase of contrast enhancement scans , respectively ( P < 0. 05 ) . The tumor involving the bile duct was
enhanced most remarkablely on 25 s phase, and the bile duct wall thickening, bile duct narrowing or
occlusion were demonstrated as the primary findings of hilar cholangiocarcinoma. The intraductal spread of
tumor could be demonstrated as small nodules on the bile duct wall proximal or distal to the tumor.
Conclusion The tumor involving the bile duct can be enhanced most remarkablely on 25 s phase after
contrast injection. Multislice helical CT, especially 3D reconstructed images, can be used to detect the
direct findings of hilar cholangiocarcinomas and the extension of tumor involving the bile duct.
【Key wor ds】 Bile duct neoplasms; Tomography, X-ray computed; Imaging, three-dimensional

肝门区胆管细胞癌的多层螺旋CT 表现.rar