Park K B, Auh Y H, Kim J H, Lee M G, Ha H K, Kim P N, Shin Y M, Kim M H, Kim H J, Min Y I
Department of Diagnostic Radiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
Abdom Imaging. 2001 Jan-Feb;26(1):48-54. doi: 10.1007/s002610000114.
We wanted to establish reasonable cholangiographic diagnostic criteria by determining the sensitivity of cholangiography in detecting choledochoceles and those factors that could compromise visualization of choledochoceles.
Over 4 years, 21 patients (seven male, 14 female; mean age = 67 years) were confirmed as having choledochoceles on endoscopic retrograde cholangiopancreatography (ERCP). Cholangiographic diagnosis was made by following three criteria: a radiolucent halo around the distal common bile duct (CBD), bulbous dilatation of the distal CBD, and the presence of sequential morphologic changes on serial cholangiography. Any two or more combinations of these three criteria were considered enough to diagnose a choledochocele on cholangiography. We compared cholangiographic imaging findings with the ERCP results.
Of 21 patients with choledochoceles, nine (43%) were correctly diagnosed on cholangiography. A radiolucent halo was present in six (28%) patients; four of these cases showed optimal duodenal filling, one showed faint duodenal filling, and one showed poor duodenal filling. The shapes of the distal CBD were bulbous, conelike, and blunt. Morphologic changes such as collapsing and bulging of the choledochocele could be seen in 12 (57%) patients on serial cholangiography. Waists were seen in 11 (52%), pseudowebs in four (19%), and wrinkling of the distal CBD in seven (33%).
Cholangiography should be obtained with optimal timing and adequate conditions to diagnose choledochocele correctly.
我们希望通过确定胆管造影在检测胆总管囊肿方面的敏感性以及那些可能影响胆总管囊肿可视化的因素，来建立合理的胆管造影诊断标准。
在4年多的时间里，21例患者（7例男性，14例女性；平均年龄 = 67岁）经内镜逆行胰胆管造影（ERCP）确诊为胆总管囊肿。通过以下三个标准进行胆管造影诊断：胆总管远端周围的透亮晕、胆总管远端的球样扩张以及在连续胆管造影上出现的连续形态学改变。这三个标准中的任何两个或更多组合被认为足以在胆管造影上诊断胆总管囊肿。我们将胆管造影成像结果与ERCP结果进行了比较。
在21例胆总管囊肿患者中，9例（43%）在胆管造影上被正确诊断。6例（28%）患者出现透亮晕；其中4例十二指肠充盈良好，1例十二指肠充盈模糊，1例十二指肠充盈不佳。胆总管远端的形状为球样、圆锥样和钝圆样。在连续胆管造影上，12例（57%）患者可见胆总管囊肿的塌陷和膨出等形态学改变。11例（52%）可见腰部，4例（19%）可见假隔，7例（33%）可见胆总管远端皱襞。
应在最佳时机和适当条件下进行胆管造影，以正确诊断胆总管囊肿。
