CT低张增强扫描在胆总管壶腹部梗阻诊断中的应用  

Application of hypotonic and enhanced CT in obstruction of ampullary portion of choledoch

作　　者：龚洪翰[1] 何来昌[1] 姜建[1] 周莉[1] 王敏君[1] 王进华[1] 王敏[1] 纪玉强[1] 邱春梅[1] 肖香佐[1] 

机构地区：[1]江西医学院第一附属医院影像科,南昌330006

出　　处：《中华放射学杂志》2005年第5期510-512,共3页Chinese Journal of Radiology

摘　　要：目的探讨CT低张增强扫描在胆总管壶腹部梗阻诊断中的应用价值.方法共47例胆总管壶腹部梗阻患者,其中男28例,女19例,年龄为34～78岁,平均年龄为52.2岁.胆总管扩张分轻度(9 mm≤管径<10 mm)、中度(10 mm≤管径<15 mm)及重度(管径≥15 mm).肝内胆管扩张的形态分软藤状、残根状和不典型3类.结果胆总管轻度扩张17例,其中3例为炎症性狭窄,14例为结石; 中度扩张18例,15例为结石,3例为壶腹癌;重度扩张12例,均为壶腹癌.肝内胆管软藤状扩张15例,均为壶腹癌;残根状扩张19例,均为胆总管结石;不典型肝内胆管扩张13例,其中3例为炎症性,10例为结石.壶腹癌中9例可见' 双管征' ,5例可见'双环征',3例可见'半月征',8例可见乳头状软组织结节影.29例结石在梗阻部位可见点状略高密度影.3例炎症性狭窄显示梗阻端胆管逐渐变细.结论 CT低张增强扫描在胆总管壶腹部梗阻的诊断和鉴别诊断中很有价值.Objective To discuss the value of hypotonic and enhanced CT scan in patient with obstruction in ampullary portion of choledoch.Methods The data of hypotonic and enhanced CT scan were reviewed and evaluated in 47 patients with obstruction in ampullary portion of choledoch. The degree of dilated common duct could be divided into three categories (low, middle, and marked grade). The configurations of intrahepatic dilated duct were divided into ‘soft bine’, ‘nub’, and atypia. Results There were low-grade dilatation of choledoch in 17 cases, middle-grade dilatation in 18 cases, and marked-grade dilatation in 12. In intrahepatic duct, there were ‘soft bine’ dilatation in 15 cases, ‘nub’ dilatation in 19 cases, and atypical dilatation in 13. In the ampullary carcinoma, there were ‘double pipe’ sign in 9, ‘double annual’ sign in 5, and ‘half-moon’ sign in 3. The soft tissue nodus of parenchyma with papilla could be seen in the dilated sections of dropping of duodenum in 8 cases. There were stippled higher densities in obstruction portion in 29 cases. Bile duct in obstruction portion showed tapering appearance in 3 cases with inflammation. Conclusion Hypotonic and enhanced CT scan is of important value in the diagnosis and differential diagnosis of the obstruction in ampullary portion of choledoch.

关 键 词：增强扫描 壶腹部 低张 CT 肝内胆管扩张 胆总管轻度扩张 诊断和鉴别诊断 胆总管扩张 胆总管结石 壶腹癌 炎症性 应用价值 平均年龄 高密度影 梗阻部位 不典型 可见 管径 双环征 结节影 软组织 乳头状 重度 中度 残根 狭窄 

分 类 号：R816.5[医药卫生—放射医学]