CAJ | 학술논문

_目的：探讨原发性十二指肠腺癌 MSCT 三期增强扫描的影像学特征，总结分析其误诊、漏诊原因。方法：回顾性分析21例经病理证实的十二指肠腺癌的临床、病理及 CT 表现特征。结果：21例十二指肠腺癌中14例呈肿块型，表现为腔内息肉状或菜花状软组织肿块，边界清晰，多呈轻中度均匀强化；6例呈缩窄型，表现为肠壁不规则或环形增厚，肠腔狭窄，常伴有近段肠管扩张，边界清楚或毛糙，可突破浆膜面，呈中度或重度均匀、不均匀强化；1例因图像质量差难以评价。累及十二指肠乳头部的腺癌常伴有肝内外胆管、胰管扩张。21例十二指肠腺癌中正确诊断13例，3例误诊为十二指肠腺瘤，1例误诊为胰头癌，2例误诊为壶腹癌。2例因 CT 检查仅表现为肝内胆管轻度扩张而漏诊。1例肝内转移灶漏诊。结论：MSCT 对十二指肠腺癌的诊断具有重要价值，保证十二指肠的充盈、重视门脉期对肝转移灶的检出以及肝内胆管轻度扩张这一间接征象，有助于更好地发现病变，降低误诊、漏诊率。
_목적：탐토원발성십이지장선암 MSCT 삼기증강소묘적영상학특정，총결분석기오진、루진원인。방법：회고성분석21례경병리증실적십이지장선암적림상、병리급 CT 표현특정。결과：21례십이지장선암중14례정종괴형，표현위강내식육상혹채화상연조직종괴，변계청석，다정경중도균균강화；6례정축착형，표현위장벽불규칙혹배형증후，장강협착，상반유근단장관확장，변계청초혹모조，가돌파장막면，정중도혹중도균균、불균균강화；1례인도상질량차난이평개。루급십이지장유두부적선암상반유간내외담관、이관확장。21례십이지장선암중정학진단13례，3례오진위십이지장선류，1례오진위이두암，2례오진위호복암。2례인 CT 검사부표현위간내담관경도확장이루진。1례간내전이조루진。결론：MSCT 대십이지장선암적진단구유중요개치，보증십이지장적충영、중시문맥기대간전이조적검출이급간내담관경도확장저일간접정상，유조우경호지발현병변，강저오진、루진솔。
To analyze the findings of duodenal adenocarcinoma on triphasic contrast enhanced multi-slice spiral CT (MSCT)scan and the cause of misdiagnosis and missed diagnosis.Methods:Twenty-one patients with duodenal adenocarcinoma verified by histopathology were collected and their MSCT findings,clinical presentations and pathological data were retrospectively analyzed.Results:14 of 21 patients were mass-forming type appearing as a small intraluminal poly-poid protrusion or cauliflower-like soft tissue mass with sharp margin and mild to moderate contrast enhancement.Six of 21 cases were constriction type showing thickened duodenal wall and narrowed duodenal canal.The lesion could have clear or rough boundary,serosal invasion,moderate or intensive homogeneous or heterogeneous enhancement,often accompanied by proximal bowel dilatation.One case was difficult to evaluate because of poor image quality.Cases involving the duodenal pa-pilla often caused dilatation of the intrahepatic and extrahepatic bile ducts and pancreatic duct.Among the 21 cases,13 were correctly diagnosed,while three cases were misdiagnosed as duodenal adenomas,one as pancreatic cancer,two as ampullary cancer.Two cases were misdiagnosed because CT showed only mild dilatation of intrahepatic bile ducts.One case with liver metastases was missed.Conclusion:Multi-slice spiral CT can well display duodenal adenocarcinoma lesions with important diagnostic values.To make duodenal fluid-filling during CT scan,and to pay attention to find any liver metastases in portal phase and mild dilatation of intrahepatic bile ducts can help to better detect duodenal lesions and to reduce misdiagnosis rate.