阴性法64层CT胆胰管成像在胆道闭锁中的诊断价值

目的：总结分析胆道闭锁的阴性法64层CT胆胰管成像（N—CTCP）的影像表现，探讨其诊断价值。方法：回顾性分析临床疑诊为胆道闭锁的52例患儿的影像资料，全部患儿行腹部增强CT门脉期扫描后采用容积重建（VR）、多平面重建（MPR）及最小密度投影（MinlP）等技术进行重建，观察并比较患儿肝内外胆道、肝门部结构、胆囊、肝脏、脾脏大小等征象的显示情况。结果：32例经手术病理证实为胆道闭锁（BA组），20例临床确诊为婴儿肝炎综合征（IHS组）。胆道闭锁的N—CTCP影像特征包括：无或小胆囊、肝门区三角形低密度区、门静脉间隙增宽，可见“双边征”或“靶征”。BA组无1例显示胆总管，4例左、右肝管可见，但管道不连续，20例出现肝、脾肿大。小胆囊、三角征及门静脉间隙增宽在IHS组与BA组中差异有统计学意义（P〈O．05），肝外胆管不显示、肝脾肿大在IHS组与BA组间差异无统计学意义（P〉0．05）。结论：胆道闭锁的N—CTCP表现具有一定特征性，肝门区三角形低密度影、小胆囊、门静脉间隙增宽出现“双边征”或“靶征”是诊断BA的重要征象。

Study on negative CT cholangiopancreatography with 64-slice CT in the diagnosis of biliary atresia

Objective：To evaluate the imaging findings of negative CT cholangiopancreatography （N CTCP） in fhe di- agnosis of biliary atresia （BA） with 64-slice CT scanner. Methods：CT imaging materials and the diagnostic value of 52 pedi- atric cases suspecting of BA were retrospectively analyzed. All cases had enhanced abdominal CT, the portal vein phase scans were post-processed with volume rendering （VR）, multi-planner reformation （MPR） and minimal intensity projection （MinIP） techniques. The intra and extra hepatic biliary ducts, structures of hepatic hilum, size of gall bladder, liver and spleen were evaluated and compared. Results：Of the 52 patients, 32 cases were surgery proven as biliary atresia and 20 cases were clinically diagnosed as infantile hepatitis syndrome （IHS）. The characteristic N-CTCP features of biliary atresia in- cluded：absence of gallbladder or small gallbladder;low attenuated triangular area around the hepatic hilum;widening of por- tal vein inter-space, showing ＂double-track sign＂ or ＂target sign＂. In patients with biliary atresia, absence of common bile duct was shown in all cases,left and right hepatic bile ducts could be revealed in 4 cases, yet showing ductal discontinuity, hepatosplenomegaly was shown in 20 eases. Significant statistic differences of small gallbladder, triangular sign and widening of portal vein inter-space were existed between BA and HIS patients （P~0.05）. While no differences were existed in ab sence of extrahepatic bile ducts or hepatosplenomegaly between BA and HIS patients. （P~0.05）. Conclusion： Certain char- acteristic N-CTCP findings of BA could be assessed. Low attenuated triangular area around hepatic hilum, small gallbladder, widening of portal vein inter-space showing ＂double track sign＂or litarget sign＂ were the key signs in the diagnosis of BA.