Cha J H, Han J K, Kim T K, Kim A Y, Park S J, Choi B I, Suh K S, Kim S W, Han M C
Department of Radiology and the Institute of Radiation Medicine, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea.
Abdom Imaging. 2000 Sep-Oct;25(5):500-7. doi: 10.1007/s002610000081.
To assess the accuracy of spiral computed tomography (CT) in predicting the resectability of Klatskin tumor as determined by vascular invasion.
Twenty-one consecutive patients with Klatskin tumor who had undergone laparotomy were included in this study. The preoperative thin-section (5-mm-thick) spiral CT scans of these patients were assessed for the surgical resectability of tumor by evaluating the vascular invasion. The criterion for vascular invasion indicating unresectability was the tumoral invasion of the proper hepatic artery or main portal vein or simultaneous invasion of one side of the hepatic artery and the other side of the portal vein.
All nine patients with tumors thought to be unresectable on the basis of CT findings had tumors that were unresectable at surgery (positive predictive value, 100%). Of 12 patients with tumors thought to be resectable, six had resectable tumors (negative predictive value, 50%). Spiral CT failed to detect small hepatic metastasis (n = 1), lymph node metastasis (n = 1), extensive tumor (n = 2) and variation of bile duct (n = 2), which precluded surgical resection.
Spiral CT is a reliable method for detecting vascular invasion and unresectable tumors. However, it has limitations in detecting variations of the bile duct or the intraductal extent of tumor.
评估螺旋计算机断层扫描（CT）在预测由血管侵犯所决定的肝门部胆管癌可切除性方面的准确性。
本研究纳入了21例连续接受剖腹手术的肝门部胆管癌患者。通过评估血管侵犯情况，对这些患者术前的薄层（5毫米厚）螺旋CT扫描结果进行肿瘤手术可切除性评估。提示不可切除的血管侵犯标准为肿瘤侵犯肝固有动脉或门静脉主干，或同时侵犯肝动脉一侧和门静脉另一侧。
所有9例根据CT表现被认为不可切除的肿瘤患者，其肿瘤在手术中均不可切除（阳性预测值为100%）。在12例被认为可切除的肿瘤患者中，6例肿瘤可切除（阴性预测值为50%）。螺旋CT未能检测到小的肝转移（1例）、淋巴结转移（1例）、广泛肿瘤（2例）及胆管变异（2例），这些情况导致无法进行手术切除。
螺旋CT是检测血管侵犯和不可切除肿瘤的可靠方法。然而，它在检测胆管变异或肿瘤的导管内范围方面存在局限性。
