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目的:研究肝门胆管癌多排螺旋CT(MDCT)动态增强扫描的CT表现及薄层重建的诊断价值。方法:回顾性分析22例经手术及病理证实的肝门胆管癌的MDCT表现;所有病例均行平扫及动态增强扫描,准直器厚度为2.5mm,常规重建图像厚度和间隔均为6mm,肝门部位行层厚和间隔3mm薄层重建。结果:22例肝门胆管癌按CT表现形式分为肿块型、结节型和壁厚型,平扫所有病灶均表现为等低密度。肿块型特点为肝门肿块,动脉期表现为轻度不均匀边缘部强化,静脉期病灶强化更明显;结节型表现为肝门部<2cm的结节,动脉期主要为边缘明显环状强化,静脉期持续明显强化,且向中心部充填;壁厚型表现为肝门部胆管壁局限性不规则增厚>2mm,动脉期及静脉期均呈明显环状强化。86.3%的病例延迟强化。薄层3mm图像对显示病灶的部位、大小、强化特征及判断肝门部侵犯等均明显优于6mm图像,10min比3min延迟显示结节更清楚。结论:肝门胆管癌动态增强CT表现有明显特征性;MDCT10min延迟扫描及薄层重建可明显提高小病灶诊断正确性。
Objective: To study the CT findings and the diagnostic value of reconstructive thin-section reconstruction of multi-slice spiral CT (MDCT) dynamic contrast-enhanced scintigraphy in hilar cholangiocarcinoma. Methods: MDCT findings of 22 cases of hilar cholangiocarcinoma confirmed by surgery and pathology were retrospectively analyzed. All patients underwent plain scan and dynamic contrast-enhanced scan. The thickness of the collimator was 2.5 mm, the thickness and interval of routine reconstructed images were 6 mm, Hepatic door line layer thickness and interval 3mm thin layer reconstruction. Results: Twenty-two cases of hilar cholangiocarcinoma were classified as lump type, nodular type and wall-thickness type according to the CT manifestations. All the lesions showed low density. Mass-type is characterized by hilar mass, arterial phase showed mild uneven edge enhancement, venous phase lesion enhancement more obvious; nodules showed hilar <2cm nodules, arterial phase was mainly marked by ring-shaped edge enhancement , The venous phase continued to be significantly enhanced, and filled to the center; wall-type showed hilar bile duct wall irregular thickening> 2mm, arterial phase and venous phase were significantly enhanced ring. 86.3% of cases delayed strengthening. 3mm thin layer images showed lesions of the site, size, enhanced features and determine the invasion of the hilar are significantly better than 6mm images, 10min delayed display nodules more clearly than 3min. Conclusions: Dynamic contrast-enhanced CT in hilar cholangiocarcinoma has obvious characteristic. Delayed scan of MDCT and thin-layer reconstruction can obviously improve the diagnostic accuracy of small lesions.