晚期肝门部胆管癌治疗前后多排螺旋CT及CT胆管造影、CT血管成像的诊断评估价值  

The diagnostic evaluation value of multidetector CT,CT cholangiography and CT angiography pre-postreatment for advanced hilar cholangiocarcinoma

作　　者：梁萍[1] 蔡金华[1] 陈更瑞[1] 邓琳[1] 闫小云 黄广仁[1] 梁美琪 张艳 黄仲奎 LIANG Ping;CAI Jinhua;CHEN Gengrui;DENG Lin;YAN Xiaoyun;HUANG Guangren;LIANG Meiqi;ZHANG Yan;HUANG Zhongkui(Department of Radiology,Beihai People's Hospital,Beihai 536000,China)

机构地区：[1]北海市人民医院放射科,广西北海536000

出　　处：《实用放射学杂志》2024年第9期1459-1462,共4页Journal of Practical Radiology

基　　金：广西自然科学基金面上项目(2020GXNSFAA297145)。

摘　　要：目的 探讨多排螺旋CT(MDCT)及CT胆管造影(CTC)、CT血管成像(CTA)重建技术在晚期肝门部胆管癌(HCCA)诊断、分型及胆管引流疗效评估的应用价值.方法 收集无法手术的晚期HCCA患者44例,于治疗前完成常规CT平扫、增强多期扫描后,运用最小密度投影(MinIP)联合曲面重建(CPR)进行CTC,运用最大密度投影(MIP)、容积再现(VR)或CPR分别进行门静脉、肝动脉、肝静脉的CTA.在胆管引流治疗后复查CT.研究内容包括CTC、CTA重建技术与常规CT扫描技术的对比,CTC在HCCA的分型诊断,CTA在血管侵犯的评估,胆管引流治疗前后的胆道成像对黄疸引流效果的评估.结果 HCCA全部获得明确的定位诊断,包括Bismuth-Corlette Ⅳ型39例,Ⅲ型5例.肝血管受累40例,包括双侧门静脉被肿瘤侵犯15例,门静脉被包绕缩窄12例,门静脉主干或分支癌栓8例,双侧肝动脉受累4例,肝静脉受累1例.CTC、CTA较常规CT扫描图像更能显示胆管、血管的全貌,对肿瘤分型及血管受侵程度分析更准确.治疗前CT显示胆管重度扩张21例,中度扩张20例,左叶肝内胆管重度扩张而右叶肝内胆管轻度扩张3例;引流治疗后,4例肝内胆管扩张缩小率<25%,13例缩小率25%~49%,18例缩小率50%~74%,9例缩小率≥75%.胆管缩小率与总胆红素(TBIL)降低率呈正相关.结论 MDCT及CTC、CTA重建技术可良好地完成晚期HCCA诊断、Bismuth-Corlette分型及血管评估;观察胆管引流治疗后的肝内胆管缩小率可对黄疸引流疗效做出评价.Objective To explore the application value of multidetector computed tomography(MDCT),computed tomography cholangiography(CTC)and computed tomography angiography(CTA)reconstruction technology in the diagnosis and classification and the evaluation of the efficacy of biliary drainage in advanced hilar cholangiocarcinoma(HCCA).Methods A total of 44 patients of inoperable advanced HCCA were collected.Conventional CT plain scan and enhanced multi-phase scan were performed before treat-ment.Minimum intensity projection(MinIP)combined with curve planar reformation(CPR)was used to perform CTC.CTA of the portal vein,hepatic artery and hepatic vein were performed by maximum intensity projection(MIP),volume rendering(VR)or CPR,respectively.CT was reexamined after biliary drainage treatment.The study included the comparison between reconstruction technology of CTC and CTA and conventional CT scanning technology,CTC in the classification and diagnosis of HCCA,CTA in the evaluation of vascular invasion,and the evaluation of the effect of jaundice drainage by biliary imaging before and after biliary drain-age treatment.Results All HCCA cases obtained clear location diagnosis,including 39 cases of Bismuth-Corlette typeⅣand 5 cases of typeⅢ.There were 40 cases of hepatic vascular involvement,including 15 cases of bilateral portal vein invasion by tumor,12 cases of portal vein constriction,8 cases of portal vein tumor thrombosis,4 cases of bilateral hepatic arteries involvement,and 1 case of hepatic vein involvement.CTC and CTA could better display a full view of the bile duct and blood vessel than conventional CT scanning ima-ges,and provided more accurate analysis of tumor classification and degree of vascular invasion.Before treatment,CT showed severe dila-tion of bile duct in 21 cases and moderate dilation in 20 cases,severe dilation of the intrahepatic bile duct in the left lobe but mild dilation of the intrahepatic bile duct in the right lobe in 3 cases.After drainage treatment,the contraction rate of intrahepatic bile d

关 键 词：肝门部胆管癌 多排螺旋CT CT胆管造影 CT血管成像 

分 类 号：R735.8[医药卫生—肿瘤] R814.42[医药卫生—临床医学] R814.43