楊立 楊州 趙紹宏 聶永康 應逸鳳 趙紅 方捷 蔡祖龍
【摘要】 目的 探討肝門區膽管細胞癌直接征象的多層螺旋CT( MSCT) 表現。方法 應用
MSCT 對19 例無痛性黃疸患者行上腹部常規平掃及靜脈注射對比劑后25 和60 s 雙期增強掃描,
15 例應用增強掃描數據行三維圖像重組, 以3 級評分法, 判斷MSCT 對肝門區膽管細胞癌直接征象的
顯示能力。分析病變膽管的形態學特征、膽管受累范圍。19 例均經手術病理( 15 例) 或內鏡逆行胰
膽管造影( ERCP, 4 例) 證實為膽管細胞癌。結果 15 例行三維圖像重組者有14 例顯示腫瘤直接征
象和腫瘤累及范圍, 19 例行25 和60 s 雙期增強掃描者分別有8 例和7 例顯示腫瘤直接征象和腫瘤
累及范圍, 三者間差異具有統計學意義( P 值均< 0. 05 ) 。注藥25 s 時腫瘤強化最明顯, 表現為肝總
管管壁環行增強、增厚、管腔局部狹窄或完全閉塞, 三維圖像呈模擬染色體樣表現, 并可觀察到病變
遠、近端膽管內播散結節。結論 MSCT 在注射對比劑后25 s 掃描, 病變增強最明顯; 三維重組圖像
可觀察膽管的直接征象和受累范圍。
【關鍵詞】 膽管腫瘤; 體層攝影術, X 線計算機; 成像, 三維
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

肝門區膽管細胞癌的多層螺旋CT 表現.rar