CAJ | 학술논문

目的分析肝内胆管乳头状肿瘤的多排螺旋CT (MSCT)表现,探讨MSCT在其诊断和鉴别诊断中的价值. 方法回顾性分析16例手术并经病理学证实的肝内胆管乳头状肿瘤的MSCT和临床资料.经方差齐性检验后,采用t检验对2组计量资料进行统计学分析. 结果 16例患者中,乳头状腺瘤9例,5例为多发,4例为单发;乳头状腺癌7例,4例为多发,3例为单发.9例乳头状腺瘤患者中,7例表现为扩张的肝内胆管内结节或肿块,CT平扫呈不均匀低密度；2例表现为胆管重度扩张,内壁毛糙如绒毛状.7例乳头状腺癌表现为扩张的肝内胆管内结节或肿块,形态及密度类似于乳头状腺瘤.增强扫描9例乳头状腺瘤均表现为轻-中度不均匀持续强化；乳头状腺癌7例,2例表现为轻-中度强化类似于乳头状腺瘤,5例持续较明显强化；1例突破胆管壁并侵犯邻近肝组织.9例瘤和7例癌患者平扫CT值差异无统计学意义(t=-1.17,P=0.2632),但动脉期(t=6.53,P＜0.01)和门静脉期(t=5.63,P＜0.01)增强CT扫描CT值差异有统计学意义.所有病例均见肝内胆管呈弥漫性或局限性不同程度扩张,4例伴胆总管中度扩张,1例癌患者见腹腔肿大淋巴结不均匀中度强化. 结论 MSCT对该肿瘤的良、恶性诊断及其与肝脏其他肿瘤的鉴别有较大价值.
목적 분석간내담관유두상종류적다배라선CT (MSCT)표현,탐토MSCT재기진단화감별진단중적개치. 방법 회고성분석16례수술병경병이학증실적간내담관유두상종류적MSCT화림상자료.경방차제성검험후,채용t검험대2조계량자료진행통계학분석. 결과 16례환자중,유두상선류9례,5례위다발,4례위단발;유두상선암7례,4례위다발,3례위단발.9례유두상선류환자중,7례표현위확장적간내담관내결절혹종괴,CT평소정불균균저밀도；2례표현위담관중도확장,내벽모조여융모상.7례유두상선암표현위확장적간내담관내결절혹종괴,형태급밀도유사우유두상선류.증강소묘9례유두상선류균표현위경-중도불균균지속강화；유두상선암7례,2례표현위경-중도강화유사우유두상선류,5례지속교명현강화；1례돌파담관벽병침범린근간조직.9례류화7례암환자평소CT치차이무통계학의의(t=-1.17,P=0.2632),단동맥기(t=6.53,P＜0.01)화문정맥기(t=5.63,P＜0.01)증강CT소묘CT치차이유통계학의의.소유병례균견간내담관정미만성혹국한성불동정도확장,4례반담총관중도확장,1례암환자견복강종대림파결불균균중도강화. 결론 MSCT대해종류적량、악성진단급기여간장기타종류적감별유교대개치.
Objective To investigate the findings of contrast-enhanced multislice computed tomography (MSCT) that characterize intraductal papillary neoplasms of bile ducts (IPNB).Methods The MSCT findings and clinical data of 16 cases of IPNB proven by surgical pathology were reviewed retrospectively.Results Among the 16 cases,nine were adenoma (multi-lesions,n=5; single lesions,n =4)and seven were adenocarcinoma (multi-lesions,n=4; single lesions,n=3).Among the nine adenoma cases,seven showed nodules or masses in the expanding intrahepatic bile ducts with asymmetrical low density on plain scan,and two showed obvious expansion of biliary ducts and the inner wall of bile ducts was rough.All seven of the adenocarcinoma cases showed nodules or masses in the expanding intrahepatic bile ducts with asymmetrical low density-like adenoma.When contrast enhancement was applied,the nine adenoma cases manifested slight-to-moderate degrees of asymmetrical enhancement.For the seven adenocarcinoma cases,two showed asymmetrical enhancement similar to that of the adenoma cases and five showed continued enhancement; one case showed malignant infiltration of the bile duct and evident damage in the adjacent hepatic tissue.The CT plain scan findings for the two groups (adenoma and adenocarcinoma) were not significantly different (t =-1.17,P =0.2632).Significantly different findings were obtained with the MSCT imaging analysis for the arterial phase (t =6.53,P ＜0.01) and the portal vein phase (t =5.63,P＜ 0.01).All cases showed asymmetrical expansion of intrahepatic biliary ducts,diffuse or local,and four cases showed moderate expansion of the common bile duct.One adenocarcinoma case showed intumescence in the celiac lymph node by moderate asymmetrical enhancement.Conclusion MSCT is helpful for the differential diagnosis of IPNB from other hepatic lesions.