CT增强延迟扫描对肝门胆管癌诊断价值的评价  

Evaluation of delayed contrast enhanced CT scan in diagnosing hilar cholangiocarcinoma

作　　者：李健丁[1] 梁晨阳[1] 张华[1] 张跃珍[1] 李睿[1] 

机构地区：[1]山西医科大学第一医院放射科,太原030001

出　　处：《中华放射学杂志》2001年第9期683-685,共3页Chinese Journal of Radiology

摘　　要：目的　评价CT在增强后动态双期扫描的基础上加作延迟扫描对肝门附近胆管癌检出的价值。方法　搜集 52例肝门部疑有肿块或梗阻的病人 ,采用螺旋CT机扫描 ,经静脉注射对比剂后于肝动、静脉期作连续扫描及延迟期 4mm薄层病灶区域连续扫描。所有病例在注射对比剂后分别于 6、8、1 0、1 5、2 0、3 0min对瘤灶作连续扫描获得系列延迟图像 ,于肝实质和肿块区连续采集CT值 ,并描绘折线图。对肿块作定量分析 ,评价其在定性诊断方面的意义。结果　 (1 ) 8～ 1 5min为延迟扫描的最佳时段。 (2 ) 2 9例胆管癌 ,动态扫描中肿瘤呈低密度 2 3例 (79 3 % )、等密度 4例 (1 3 8% )、高密度2例 (6 9% )。延迟图像中肿瘤呈等密度 8例 (2 7 6% )、高密度 2 1例 (72 4% )、无低密度者。延迟扫描可使大部分胆管癌呈现相对高密度 (U =- 4 .3 0 73 ,P <0 0 1 ) ,使肿瘤边界明确化。 (3 )肝门肿块及梗阻病例 ,延迟期肝门转移性肿块无一例呈相对高密度 ,延迟三相扫描可有效区分胆管癌和引起梗阻的其他原因 (χ2 =9.0 9,P <0 0 1 )。结论　评价肝门部肿块时 ,在动态扫描的基础上加作 8～ 1 5min延迟扫描有助于肝门胆管癌的检出。Objective To assess the diagnostic value of delayed CT contrast enhancement patterns in hilar cholangiocarcinoma based on two phased dynamic incremental CT scanning. Methods Fifty two patients with suspected hilar tumor and bile duct obstruction underwent spiral CT scan. The scan time for one revolution of the X ray tube was 1 second. To elucidate the delay time for optimal imaging, all proved cholangiocarcinoma with delayed (6、8、10、15、20、30 minutes) post equilibrium phase contrast enhanced CT scans were acquired with unenhanced, dynamic contrast enhanced, and delayed images. Degree of delayed enhancement was compared with that of surrounding liver parenchyma. Results (1) 8～15 minutes after IV injection of contrast material was the delay time for optimal imaging. (2) Of 29 cholangiocarcinomas, the early CT showed hypoattenuating (lower than that of liver parenchyma) in 23 tumors, isoattenuating (equal to that of the liver) in 4 tumors, and hyperattenuating (higher than that of liver) in 2 tumors. The delayed CT scan showed isoattenuating in 8 tumors, hyperattenuating in 21 tumors, and no hypoattenuating. Most of delay imaging of hilar cholangiocarcinoma may appear hyperattenuating ( U=-4.307 3, P <0.01). (3) None of the hilar metastatic mass showed hyperattenuating at the delayed scan, making it possible to differentiate between cholangiocarcinoma and other lesions causing hilar obstruction (χ 2=9.09, P <0.01). Conclusion When assessing hilar tumor, delayed CT contrast enhancement patterns based on two phase dynamic incremental CT scans is useful in the detection and characterization of hilar cholangiocarcinoma.

关 键 词：胆管癌 体层摄影术 X线计算机 图像增强 诊断 影像学表现 

分 类 号：R735.8[医药卫生—肿瘤]