胆管内乳头状肿瘤的动态增强CT表现
담관내유두상종류적동태증강CT표현
Dynamic contrast-enhanced CT appearances of the intraductal papillary neoplasms of the bile duct
  • 万方数据
    中华放射学杂志 중화방사학잡지
    Chinese Journal of Radiology
    2013年 5期 430-435 ,共6页

    宋凤祥%周建军%施裕新%曾蒙苏%周康荣%周俊%丁玉芹%何德明

    송봉상%주건군%시유신%증몽소%주강영%주준%정옥근%하덕명

    胆管肿瘤%体层摄影术,X线计算机%病理学 膽管腫瘤%體層攝影術,X線計算機%病理學
    담관종류%체층섭영술,X선계산궤%병이학
    Bile duct neoplasms%Tomography,X-ray computed%Pathology
    目的 探讨胆管内乳头状肿瘤CT动态增强的表现及其病理基础.方法 回顾性分析16例经手术病理证实的胆管内乳头状肿瘤患者资料,所有患者术前均行CT平扫及动态增强扫描,分析其CT征象并与手术病理对照.其中12例共38个病灶(非癌变组4例17个病灶、癌变组8例21个病灶)可清晰显示,测量各扫描期肿瘤的CT值及平扫胆管内胆汁的CT值.搜集近期行腹部CT检查表现正常的40名受检者作为正常对照组和40例胆结石患者作为胆石症组,测量其平扫胆管内胆汁的CT值,用于和胆管内乳头状肿瘤比较.非癌变和癌变胆管内乳头状肿瘤组织各期相CT值比较采用独立样本t检验,远端胆管扩张情况的比较采用Fisher确切概率法,和正常对照组及胆石症患者的平扫胆汁CT值比较采用秩和检验.结果 16例中,肿瘤位于肝左叶者8例,肝右叶者1例,左、右叶均受累者1例,肝门部1例,胆总管3例,肝右叶及胆总管均受累者2例.胆管内肿瘤呈乳头状11例、扁平状3例,两种形态并存者1例,1例CT未发现明确肿瘤组织,仅见胆道系统扩张和胆管结石.非癌变胆管内乳头状肿瘤平扫、动脉期、门静脉期CT值分别为(25.8±8.0)、(37.7±10.3)和(51.7±17.1)HU,癌变胆管内乳头状肿瘤CT值分别为(38.4±10.2)、(56.6±18.0)和(68.4± 13.4) HU,癌变肿瘤CT值高于非癌变肿瘤,差异均有统计学意义(t值分别为-3.510、-3.549和-3.767,P值均＜0.01).胆管内乳头状肿瘤患者平扫胆汁CT值(中位值为5.8 HU)高于正常对照组(中位值为0.4 HU)和胆管结石患者(中位值为2.4 HU),差异均有统计学意义(Z值分别为3.854和2.765,P值均＜0.01).16例均见肿瘤近端胆管扩张,11例合并远端胆管扩张,癌变肿瘤远端胆管扩张＞ 100％者7例,多于非癌变组2例,但差异无统计学意义(P＞0.05).6例合并结石,其中3例结石位于病变区域,3例结石距病变部位较远.结论 胆管内乳头状肿瘤常见于肝左叶,多呈乳头状；CT平扫肿瘤密度偏低,动态增强后呈轻、中度进行性延迟强化,癌变的肿瘤组织CT值高于未癌变者；肿瘤近、远端胆管均可扩张；胆汁的CT值比正常人及胆结石患者稍高；可合并肿瘤区域或非肿瘤区域的胆管结石.
    목적 탐토담관내유두상종류CT동태증강적표현급기병리기출.방법 회고성분석16례경수술병리증실적담관내유두상종류환자자료,소유환자술전균행CT평소급동태증강소묘,분석기CT정상병여수술병리대조.기중12례공38개병조(비암변조4례17개병조、암변조8례21개병조)가청석현시,측량각소묘기종류적CT치급평소담관내담즙적CT치.수집근기행복부CT검사표현정상적40명수검자작위정상대조조화40례담결석환자작위담석증조,측량기평소담관내담즙적CT치,용우화담관내유두상종류비교.비암변화암변담관내유두상종류조직각기상CT치비교채용독립양본t검험,원단담관확장정황적비교채용Fisher학절개솔법,화정상대조조급담석증환자적평소담즙CT치비교채용질화검험.결과 16례중,종류위우간좌협자8례,간우협자1례,좌、우협균수루자1례,간문부1례,담총관3례,간우협급담총관균수루자2례.담관내종류정유두상11례、편평상3례,량충형태병존자1례,1례CT미발현명학종류조직,부견담도계통확장화담관결석.비암변담관내유두상종류평소、동맥기、문정맥기CT치분별위(25.8±8.0)、(37.7±10.3)화(51.7±17.1)HU,암변담관내유두상종류CT치분별위(38.4±10.2)、(56.6±18.0)화(68.4± 13.4) HU,암변종류CT치고우비암변종류,차이균유통계학의의(t치분별위-3.510、-3.549화-3.767,P치균＜0.01).담관내유두상종류환자평소담즙CT치(중위치위5.8 HU)고우정상대조조(중위치위0.4 HU)화담관결석환자(중위치위2.4 HU),차이균유통계학의의(Z치분별위3.854화2.765,P치균＜0.01).16례균견종류근단담관확장,11례합병원단담관확장,암변종류원단담관확장＞ 100％자7례,다우비암변조2례,단차이무통계학의의(P＞0.05).6례합병결석,기중3례결석위우병변구역,3례결석거병변부위교원.결론 담관내유두상종류상견우간좌협,다정유두상；CT평소종류밀도편저,동태증강후정경、중도진행성연지강화,암변적종류조직CT치고우미암변자；종류근、원단담관균가확장；담즙적CT치비정상인급담결석환자초고；가합병종류구역혹비종류구역적담관결석.
    Objective To analyze the dynamic contrast-enhanced CT appearances of intraductal papillary neoplasms of the bile duct and improve its diagnostic accuracy.Methods Sixteen patients with intraductal papillary neoplasms of the bile duct confirmed histopathologically after surgical operation underwent dynamic contrast-enhanced multi-detector row CT scans.All imaging data were reviewed and analyzed retrospectively in correlation with surgical and pathological findings.CT values of 38 well-visualized lesions in 12 of the 16 patients at the pre-contrast phase,arterial phase and venous phase were measured.Four of the 12 patients with 17 lesions had benign tumors,and 8 of the 12 patients with 21 lesions had malignant tumors.Comparisons of CT values at the three phases between the two groups were carried out using independent sample t test.The bile CT values were measured in these 12 cases,40 normal volunteers,and 40 subjects with bile duct stones,and the Wilcoxon signed-rank test was applied to compare the bile CT values between tumor group and the normal group and between tumor group and the bile duct stone group.The diameters of the bile ducts proximal to and distal to tumors were also measured,and Fisher exact method was carried to analyze the data.Results Lesions located at the left lobe in 8 out of the 16 patients,the right lobe in 1 case,both the left and right lobes in 1 case,the hepatic hilum in 1 case,the common bile duct in 3 cases,and both the right lobe and the common bile duct in 2 cases.Eleven lesions appeared as papillary masses,3 as flat masses,1 as mixed papillary and flat masses.In one case,tumor mass could not be definitely visualized,and only dilated bile ducts and stones were demonstrated.The mean CT values of the benign tumors were (25.8 ± 8.0),(37.7 ± 10.3) and (51.7 ± 17.1) HU respectively at pre-contrast phase,arterial phase,and venous phase,and the malignant tumors were (38.4 ± 10.2),(56.6 ± 18.0) and (68.4 ± 13.4) HU respectively.The CT values of malignant tumors were higher than the benign tumors at all three phases(t =-3.510,-3.549 and-3.767,P ＜ 0.01).The median bile CT value was 5.8 HU in intraductal papillary neoplasms,0.4 HU in the normal control group,and 2.4 HU in the group with bile duct stones,the median CT value of tumor group was higher than either the normal group or the group with bile duct stones (Z =3.854 and 2.765,P ＜ 0.01).All the patients showed proximal bile ducts dilatation,and 11 patients exhibited additional distal bile ducts dilatation.Proximal bile duct dilatation of more than 100％was seen in 7 cases in the malignant group,whereas only 2 patients in the benign group,but there was no significant difference (P ＞ 0.05).Bile duct stones were noted in six cases,three at the tumor area,and the remaining three away from tumor.Conclusions Intraductal papillary neoplasms of the bile duct involve the left lobe more frequently.At pre-contrast CT,the tumor density is low.On dynamic contrast-enhanced CT,tumors show mild to moderate enhancement with gradual delayed enhancement.Malignant tumors show higher CT values than benign ones.Both proximal and distal bile ducts may be dilated.The CT values of the bile in the tumor group are mildly higher than either the normal control group or the group with bile duct stones.Bile duct stones can be noted at or away from the tumor area.
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