多层螺旋CT在壶腹周围癌中的诊断价值

目的探讨多层螺旋CT在壶腹周围癌中的诊断价值。材料和方法回顾性分析经病理证实的76例壶腹周围癌的CT表现。结果发现胆道梗阻65例,位于胰上段20例,胰腺段18例,壶腹段27例。梗阻面管腔形态分为截断型30例,漏斗型或鸟嘴型20例,鼠尾型15例。＂双管征＂出现60例,其中胰胆管相交19例,胰胆管分离25例,梗阻近端胰管未扩张16例。CT明确检出肿物63例,CT表现为异常10例,CT未发现病变3例。检出的63例病灶全部有不同程度的强化,根据来源不同,强化方式有所区别。手术病理证实淋巴结转移29例。结论 CT可以准确检出壶腹周围癌所致胆道梗阻。沿着梗阻段结合增强扫描,CT可检出肿瘤。多期增强扫描对于鉴别肿瘤起源有帮助。多层螺旋CT在壶腹周围癌的诊断上有实用价值,但存在一定的局限性,需要综合应用各种检查手段,以提高诊断准确性。

Diagnostic value of multi-slice spiral CT in periampullary carcinoma

Purpose To evaluate the role of multi-slice spiral CT in the diagnosis of periampullary carcinoma.Material and Methods We respectively studied the preoperative data of multi-slice spiral CT performed on 76 patients with periampullar carcinoma.All patients were confirmed by pathological diagnosis after operation.Results There were 65 patients with biliary duct obstruction,including 20 cases in the upper pancreas,18 cases in pancreatic segment,and 27 cases in ampullary segment.The shapes of obstructive segements were termination type（30 cases）,funnel-shaped or beak-type（20 cases）,rat tail type（15 cases）.＂Double-duct-sign＂ were found in 60 cases,of which intersects of pancreatic and biliary ducts in 19 cases,isolated pancreatic and biliary ducts in 25 cases,proximal pancreatic duct obstruction with no dilatation in 16 cases.On CT scan,53 cases were cleary shown with mass,10 cases with abnormalities,and 3 cases with no lesion.All 63 cases of lesions showed different degrees of contrast enhancement,according to different origins of cancers.29 cases were pathologically confirmed with lymph node metastasis.Conclusions CT can accurately detect biliary obstruction caused by periampullary carcinoma.By examining along the biliary obstruction and combination with enhanced scanning,CT can find the primary tumor.Multi-phase enhanced scan may help to identify the origin of tumor.Multi-slice spiral CT in the diagnosis of periampullary carcinoma has practical value,but there are some limitations.Various inspection tools need to be combined to improve the diagnostic detection rate.