摘要
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。经方差齐陛检验后，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一中度不均匀持续强化，乳头状腺癌7例，2例表现为轻一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。
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, a = 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 medal 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.
出处
《中华肝脏病杂志》
CAS
CSCD
北大核心
2012年第10期789-793,共5页
Chinese Journal of Hepatology
