Moon S G, Han J K, Kim T K, Kim A Y, Kim T J, Choi B I
Department of Radiology, Seoul National University College of Medicine, Chongno-gu, Seoul 110-744, Korea.
Abdom Imaging. 2003 Jan-Feb;28(1):45-52. doi: 10.1007/s00261-001-0191-8.
We describe the thin-section helical computed tomographic (CT) findings of biliary obstruction caused by metastasis.
Thin-section helical CT (5 mm slice thickness, 1:1 pitch, portal phase) and direct cholangiography in 50 consecutive patients with biliary obstruction caused by metastases were reviewed retrospectively by three radiologists. The primary sites were the stomach ( n = 36), colon ( n = 12), jejunum ( n = 1), and uterus ( n = 1). The level of biliary obstruction was analyzed with the Bismuth classification, and the CT findings of biliary obstruction were classified into six types: small (<2 cm) periductal masses, large (>/=2 cm) periductal masses, extrinsic compression by a metastatic liver mass, high-attenuation intraductal mass, intrapancreatic mass, and no demonstrable lesion.
The level of biliary obstruction was the hilum in 18 patients (36%), the proximal common duct in 20 (40%), the distal common duct in five (10%), and the periampullary area in seven (14%). Of 18 hilar obstructions, tumor involvement of the secondary confluence of intrahepatic bile ducts was seen in 10 (right in six, left in one, and bilateral in three). Periductal masses were seen in 68% (small in 18, large in 16). In one patient (2%), a large metastatic mass of the liver resulted in extrinsic compression and biliary obstruction. Lesions mimicking primary biliary or pancreatic tumor were seen in four, respectively. In seven, we found no obstructing lesion on CT.
Biliary obstruction in patients with known primary malignancies can show atypical patterns mimicking primary pancreatobiliary malignancies on thin-section helical CT.
我们描述了由转移瘤引起的胆道梗阻的薄层螺旋计算机断层扫描（CT）表现。
三位放射科医生回顾性分析了50例由转移瘤引起胆道梗阻患者的薄层螺旋CT（层厚5mm，螺距1:1，门静脉期）及直接胆管造影。原发部位为胃（n = 36）、结肠（n = 12）、空肠（n = 1）和子宫（n = 1）。采用Bismuth分类法分析胆道梗阻水平，将胆道梗阻的CT表现分为六种类型：小（<2cm）胆管周围肿块、大（≥2cm）胆管周围肿块、转移性肝肿块的外在压迫、高密度胆管内肿块、胰内肿块及未发现病变。
18例（36%）患者的胆道梗阻水平为肝门部，20例（40%）为肝总管近端，5例（10%）为肝总管远端，7例（14%）为壶腹周围区域。在18例肝门部梗阻中，10例可见肝内胆管二级汇合处受肿瘤侵犯（右侧6例，左侧1例，双侧3例）。68%可见胆管周围肿块（小肿块18例，大肿块16例）。1例（2%）患者肝脏的大转移瘤导致外在压迫及胆道梗阻。分别有4例表现类似原发性胆管或胰腺肿瘤。7例患者CT上未发现梗阻性病变。
已知原发性恶性肿瘤患者的胆道梗阻在薄层螺旋CT上可表现出类似原发性胰胆管恶性肿瘤的非典型模式。
