摘要
目的：探讨ＣＴ和ＭＲ在壶腹周围癌检测中的应用价值。方法：对３７例经手术病理证实的壶腹周围癌进行回 顾性分析，并就其ＣＴ和ＭＲ表现与２５例正常腹部ＣＴ资料作对照分析。结果：壶腹部肿块为壶腹周围癌的主要征象，肿块 远端胰腺不同程度萎缩、稀疏，胰后脂肪间隙模糊，胆总管远端和胰管近端间距增宽，ＭＲＣＰ显示扩张胆总管远端呈“鼠尾” 状改变等征象。部分壶腹癌不能明确显示肿块，但胆总管远端和胰管近端间距缩小，ＭＲＣＰ显示扩张胆总管远端呈截断表 现对诊断有帮助。胆总管远端癌表现肝内外胆管高度扩张，并在扩张的胆总管内见软组织影。十二指肠乳头癌典型表现 为十二指肠降段肠腔内充盈缺损或局部肠壁增厚，但与壶腹癌甚难区别。结论：ＣＴ仍是目前诊断壶腹周围癌的首选检查 方法，ＭＲＩ及ＭＲＣＰ对胆系梗阻的定位和胰管的显示有其优势，ＣＴ和ＭＲ相结合可提高诊断的准确性。
Objective : To evaluate the value of CT and MRI in diagnosis of cancer around ampulla. Methods: The CT and MRI studies of 37 cases with cancer around ampulla confirmed by surgical pathology were reviewed retrospectively and compared with the CT findings of 25 cases of normal abdomen. Results: The main appearance of cancer around ampulla was presented as the mass on images in 91.89% (34/37) ,and the other findings included the atrophy of pancreas distal to the mass at different degrees, the obscurity in retropan- creatic space,and the increasing distance between distal common bile duct(CBD) and proximal pancreatic duct as well as dilated distal CBD as 'mouse tail' in shape on MRCP. Some of ampullaiy cancer weren't presented as the mass, but appeared the decreased distance between the distal CBD and proximal pancreatic duct and the end of the dilated CBD as 'cut-of' sign on MRCP, which would be helpful to indicate the ampullary cancer.The serious dilation of intrahepatic biliaiy duct and CBD and soft tissue in dilated CBD were documented in the cancer at the end of CBD. The typical features of the cancer of duodenal papilla showed filling defect in descending palt of and local thickening wall of the duodenum, but which was poorly differentiated in ampullaiy cancer. Conclusion: CT scanning is so far the first method of choice in the diagnosis of the cancer around ampulla, however, MRI and MRCP have the advantage in localization of the ob- struction of bile duct and display of pancreatic duct. CT scans, together with MRI, may improve the diagnostic accuracy.
出处
《放射学实践》
2000年第6期399-402,共4页
Radiologic Practice
