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Abstract
目的 探讨肝门区胆管细胞癌直接征象的多层螺旋CT(MSCT)表现.方法应用MSCT对19例无痛性黄疸患者行上腹部常规平扫及静脉注射对比剂后25和60 s双期增强扫描,15例应用增强扫描数据行三维图像重组,以3级评分法,判断MSCT对肝门区胆管细胞癌直接征象的显示能力.分析病变胆管的形态学特征、胆管受累范围.19例均经手术病理(15例)或内镜逆行胰胆管造影(ERCP,4例)证实为胆管细胞癌.结果 15例行三维图像重组者有14例显示肿瘤直接征象和肿瘤累及范围,19例行25和60 s双期增强扫描者分别有8例和7例显示肿瘤直接征象和肿瘤累及范围,三者间差异具有统计学意义(P值均<0.05).注药25 s时肿瘤强化最明显,表现为肝总管管壁环行增强、增厚、管腔局部狭窄或完全闭塞,三维图像呈模拟染色体样表现,并可观察到病变远、近端胆管内播散结节.结论 MSCT在注射对比剂后25 s扫描,病变增强最明显;三维重组图像可观察胆管的直接征象和受累范围.
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