硬化性胆管炎与胆总管癌的影像鉴别诊断  

Imaging and differential diagnosis of sclerosing cholangitis and periductal infiltrating cancer in the common bile duct

作　　者：杜德坤[1] 欧志强[1] 邓志国[1] 

机构地区：[1]暨南大学第四附属医院放射科,广东广州510220

出　　处：《医学影像学杂志》2013年第12期1959-1961,共3页Journal of Medical Imaging

基　　金：广东省广州市医药卫生科技项目(编号:20112131220090)

摘　　要：目的探讨CT和胆道造影对硬化性胆管炎和胆总管浸润癌的影像特征并评价其诊断区别。方法对18例经手术病理证实的胆总管癌与4例临床诊断的硬化性胆管炎的CT和PTC、ERCP、MRCP的影像学表现进行分析。结果4例硬化性胆管炎表现胆总管壁较薄,边界更加光整,管壁向心性增厚,狭窄近段胆管轻度扩张;CT增强扫描呈明显强化,胆道造影表现管腔渐进性、均匀的狭窄,与胆管癌比较表现多灶性狭窄并有沙漏样改变。结论 CT和胆道造影能有效区分硬化性胆管炎和胆总管浸润癌病变,密切结合临床综合分析,对于两种疾病的鉴别诊断有重要的价值。Objective To compare findings at computed tomography （CT）, cholangiography in patients with sclerosing cholangitis （SC） and periductal infiltrating cancer in the common bile duct （CBD）, and to evaluate the diagnostic perform ance in differentiation between the two diseases. Methods Bile duct changes at dynamic CT, PTC, ERCP and MRCP were reviewed retrospectively in 4 patients with SC and 18 patients with periductal infiltrating CBD cancer. Results At CT, SC was thinner CBD walls, concentric wall thickening, smooth outer margins, and lower degrees of upstream ductal dilatation and contrast enhancement than CBD cancer. At cholangiography, SC was more frequently associated with smooth margins, gradual and symmetric narrowing, multifocal involvement and hourglass appearance than CBD cancer. Conclusion CT and cholangiography can be helpful in distinguishing SC from periductal infiltrating CBD cancer. Com bined with clinical data has the important values in differentiation between the two diseases.

关 键 词：硬化性胆管炎 胆总管癌 肝管造影术 体层摄影术 X线计算机 

分 类 号：R814.42[医药卫生—影像医学与核医学]