64排CT多期扫描对原发恶性低位梗阻性黄疸的鉴别诊断  

Differential Diagnosis of Primary Malignant Low-level Obstructive Jaundice by 64-row Spiral CT Multi-phase Scan

作　　者：杨春波[1] 王滨[1] 周茂义[1] 刘静[1] 李丽新[1] 张东雯[1] 

机构地区：[1]潍坊医学院附属医院影像中心,山东潍坊261031

出　　处：《实用放射学杂志》2009年第9期1279-1281,共3页Journal of Practical Radiology

基　　金：潍坊医学院科技计划项目（编号：2003-001）.

摘　　要：目的探讨原发恶性低位梗阻性黄疸的螺旋CT（SCT）表现特点。方法35例原发性低位梗阻性黄疸患者行64排SCT多期扫描（平扫、动脉期、静脉期及延迟期），所有病例均经手术、病理证实，其中包括胰头癌15例，胆总管癌9例，壶腹癌11例。对比分析其特征性的SCT征象。结果胰头癌中，病灶平扫及增强扫描均呈低密度，边界不清，肝内、外胆管扩张的程度与病灶的大小、位置、病程有相关性，半数以上有胰体、尾部的萎缩；胆总管癌中，病灶均较局限，边界较清，平扫呈等密度，强化程度最明显，梗阻近端胆总管壁偏环形增厚，肝内、外胆管扩张较重；壶腹癌中，病灶呈圆形等密度结节，边缘规则，强化程度高于胰头癌，低于胆总管癌，胆管全程扩张，“双管征”的显示率为100％。结论64排SCT多期扫描在原发恶性低位梗阻性黄疸的病因鉴别诊断中发挥着关键作用。Objective To study the spiral CT findings of the primary malignant low-level obstructive jaundice. Methods 35 cases of primary malignant low-level obsturctive jaundice were examined with 64-SCT multi-phase scans（ plain, artery, vein and delay phase）,all cases were proved by surgery and pathology, Of them, 15 cases were pancreatic head cancer,9 cases were bile duct cancer and 11 cases were ampulla carcinoma. SCT characteristics were analysed. Results Pancreatic head carcinomas apperaed as low density on both plain and enhanced scans with indefinite boundary. The extent of the bile duct dilation was relevant with the size,location, course of lesions. In common bile duct cancer, the lesions were localized with definite, and were border is clear, obvious enhanced. The proximal walls of commonn bile ducts were circular thickness ,the bile ducts internal and external liver were obviously expansion. In ampulla cancer,the lesions appeared as round isointense nodules with regular form. The enhanced degree of the lesions was higher than that of pancreatic head carcinomas and lower than that of bile duct carcinomas, the ＂double-duct sign＂ presented in all cases. Conclusion 64- SCT multi- phase scan plays important role in diagnosis and differential diagnosis of the primary malignant low-level obsturctive jaundice.

关 键 词：胰头癌 胆总管癌 壶腹癌 梗阻性黄疸 体层摄影术 X线计算机 

分 类 号：R575[医药卫生—消化系统] R814.42[医药卫生—内科学]