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目的：探讨ＣＴ和ＭＲ在壶腹周围癌检测中的应用价值。方法：对３７例经手术病理证实的壶腹周围癌进行回 顾性分析，并就其ＣＴ和ＭＲ表现与２５例正常腹部ＣＴ资料作对照分析。结果：壶腹部肿块为壶腹周围癌的主要征象，肿块 远端胰腺不同程度萎缩、稀疏，胰后脂肪间隙模糊，胆总管远端和胰管近端间距增宽，ＭＲＣＰ显示扩张胆总管远端呈“鼠尾” 状改变等征象。部分壶腹癌不能明确显示肿块，但胆总管远端和胰管近端间距缩小，ＭＲＣＰ显示扩张胆总管远端呈截断表 现对诊断有帮助。胆总管远端癌表现肝内外胆管高度扩张，并在扩张的胆总管内见软组织影。十二指肠乳头癌典型表现 为十二指肠降段肠腔内充盈缺损或局部肠壁增厚，但与壶腹癌甚难区别。结论：ＣＴ仍是目前诊断壶腹周围癌的首选检查 方法，ＭＲＩ及ＭＲＣＰ对胆系梗阻的定位和胰管的显示有其优势，ＣＴ和ＭＲ相结合可提高诊断的准确性。
Objective: To investigate the value of CT and MR in the detection of periampullary cancer. METHODS: Retrospective analysis was performed on 37 cases of periampullary cancer confirmed by surgery and pathology. CT and MR findings were compared with those of 25 cases of normal abdominal CT. Results: The ampulla mass was the main sign of periampullary cancer. The distal pancreas was atrophied and sparse in different degrees. The fat space behind the pancreas was blurred. The distance between the distal common bile duct and the pancreatic duct was widened. MRCP showed the distal end of the dilatation of the common bile duct. There are changes such as “rat tail”. Some ampullary carcinomas do not clearly show masses, but the distance between the distal common bile duct and the proximal pancreatic duct is reduced. MRCP shows that the distal part of the dilated common bile duct is truncated to help diagnose. The distal common bile duct cancer shows a high degree of dilation of the intrahepatic bile ducts and soft tissue shadows in the dilated common bile duct. Duodenal papillary carcinoma is typically expressed as a filling defect in the descending duodenum of the duodenum or local thickening of the intestinal wall, but it is very difficult to distinguish from ampullary cancer. Conclusion: CT is still the preferred method for diagnosing periampullary cancer. MRI and MRCP have advantages in locating biliary obstruction and displaying pancreatic duct. The combination of CT and MR can improve the accuracy of diagnosis.