胆管导管内乳头状肿瘤的多层螺旋CT表现及其良恶性鉴别  

Multi spiral CT findings of intraductal papillary neoplasm of the bile duct and its benign and malignant differentiation

作　　者：周赵霞 汪建华[1] 周伟健 何秀超 ZHOU Zhaoxia;WANG Jianhua;ZHOU Weijian;HE Xiuchao(Department of Imaging,the First Affiliated Hospital of Ningbo University,Ningbo,Zhejiang Province 315020,China)

机构地区：[1]宁波大学附属第一医院影像科,浙江宁波315020

出　　处：《实用放射学杂志》2024年第3期398-401,共4页Journal of Practical Radiology

摘　　要：目的探讨胆管导管内乳头状肿瘤(IPNB)的多层螺旋CT(MSCT)特征及其良恶性的鉴别.方法回顾性分析经病理证实的23例IPNB患者的MSCT和临床资料,根据病理分为良性组和恶性组,良性组12例(低至中级别上皮内瘤变7例,高级别上皮内瘤变5例),恶性组11例(侵袭性癌).所有患者均行上腹部CT平扫及3期增强扫描,增强扫描包括动脉期、门静脉期及延迟期,分析肿瘤的发病部位、大小、生长方式、强化方式、侵犯与转移、胆管表现及是否合并结石.肿瘤横径、纵径及纵横比等计数资料采用独立样本t检验,肿瘤生长方式、发病部位、强化方式等分类变量采用卡方检验比较良性组与恶性组之间的差异.结果良性IPMB组及恶性IPMB组在发病部位、肿瘤横径、胆管扩张、合并结石差异无统计学意义(P>0.05);肿瘤生长方式、肿瘤纵径及纵横比、强化方式、侵犯胆管壁、胆管截断差异有统计学意义(P<0.05).结论IPNB良性者多见,当IPNB呈弥漫型生长、渐进型强化、浸润胆管壁并侵犯胆管外结构、远处转移时,提示肿瘤为恶性,最终确诊仍需病理诊断.Objective To investigate the multi spiral computed tomography(MSCT)characteristics of intraductal papillary neo-plasm of the bile duct(IPNB)and to distinguish the benign and malignant ones.Methods The MSCT and clinical data of 23 patients with IPNB confirmed by pathology were analyzed retrospectively.According to the pathology,they were divided into benign and malignant groups,including 12 cases of benign group(7 cases with low to medium grade intraepithelial neoplasia,and other 5 cases with high grade intraepithelial neoplasia)and 11 cases of malignant group with invasive carcinoma.All patients underwent plain and tri-phasic enhanced CT scans of upper abdomen.The enhanced scan included arterial phase,portal phase and delayed phase.The location,size,growth mode,enhancement type,invasion and metastasis,bile duct manifestations and bile duct stones were analyzed.Independent sample t-test was used to count the transverse diameter,longitudinal diameter and aspect ratio of tumor.Chi square test was used to compare the difference in other parameters between benign and malignant groups.Results There were no significant differences between benign and malignant IPNB groups in the location of the disease,the transverse diameter of the tumor,the dilatation of the bile duct and the presence of the stones(P>0.05).However,the significant differences in tumor growth mode,tumor longitudinal diameter and aspect ratio,enhancement type,invasion of bile duct wall and bile duct truncation were found(P<0.05).Conclusion Benign IPNB is common,while the IPNB with diffuse growth,progressive enhancement,invasion of bile duct wall and extrabiliary structures,and distant metastasis may indicate malignance,and the final diagnosis depends on the pathology.

关 键 词：胆管肿瘤 乳头状瘤 计算机体层成像 

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