双期多层螺旋CT对胆囊癌手术可切除性评价  

Evaluation of Resectability for Carcinoma of the Gallbladder with Dual-phase Multislice Spiral CT

作　　者：王向明[1] 黄文鑫浙江大学附属邵逸夫医院放射科 

机构地区：[1]浙江省义乌市中心医院放射科,浙江义乌322000

出　　处：《实用放射学杂志》2008年第8期1062-1065,共4页Journal of Practical Radiology

摘　　要：目的探讨多层螺旋CT(MSCT)双期扫描三维重建预测胆囊癌手术可切除性的价值。方法40例临床和超声检查疑为胆囊癌的患者接受前瞻性MSCT双期扫描,其中剖腹探查行胆囊癌根治性切除术和姑息性切除术35例。剖腹探查患者MSCT双期扫描的图像行3D容积再现重建和多平面重建,根据其表现进行分期、评估血管侵犯情况和血管解剖、预测手术可切除性,并与手术结果对照。结果根据CT表现,13例为可切除,22例为不可切除。手术可切除17例,不可切除18例。CT分期偏高4例。手术可切除敏感性为76.5%,特异性100%,阳性预测值100%,阴性预测值为81.8%,准确性为88.6%。肝脏、血管、胆管侵犯,腹主动脉淋巴结转移,CT诊断与手术的符合率为100%。CT显示9例血管变异,6例在根治性切除术中证实。结论MSCT双期扫描三维重建有助于预测胆囊癌手术可切除性和制定根治性手术血管入路。Objective To evaluate the value of dual - phase MSCT with 3D reconstruction in the staging and resectability of gallbladder carcinoma. Methods Forty patients with suspected gallbladder carcinoma by clinical examination and routine sonography were prospectively studied with dual - phase MSCT. Of these patients, only 35 who underwent a laparotomy for extended cholecystectomy or a palliative surgery were included in the study. Three - dimensional volume rendering and multiplanar reformation was used for evaluation of the vascular invasion and anatomy. The staging and resectability of lesions determined by CT and the results were compared with operative findings. Results On the basis of the CT findings, 13 tumors were resectable and 22 were unresectable. On surgery, 17 tumors were found to be resectable and the remaining was unresectable. Overstaging by CT occurred in 4 patients due to overassessment of duodenal infiltration, pancreatic infiltration and colonal infiltration. CT had a sensitivity of 76.5% , a specificity of 100% , an accuracy of 88.6% , a positive predictive value of 100% and negative predictive value of 81.8% in determining resectability of gallbladder carcinoma. For the diagnosis of hepatic and vascular invasion, and involvement of bile duct by the tumor, there was 100% correlation between CT and surgery. Vascular variations were found in six of 17 patients who underwent radical cholecystectomy. Conclusion Dual - phase MDCT with 3D reconstruction can predict resectability of gallbladder carcinoma and determine the vascular road map before surgery.

关 键 词：腹部 胆囊癌 多层 螺旋 体层摄影术 X线计算机 

分 类 号：R735.8[医药卫生—肿瘤] R814.42[医药卫生—临床医学]