Watadani Takeyuki, Akahane Masaaki, Yoshikawa Takeharu, Ohtomo Kuni
Department of Radiology, School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Radiat Med. 2008 Aug;26(7):402-7. doi: 10.1007/s11604-008-0249-4. Epub 2008 Sep 4.
Our aim was to investigate the diagnostic reliability of multidetector-row computed tomography (MDCT) for preoperative assessment of local tumoral spread in hilar cholangiocarcinoma. MATEIRALS AND METHODS: Thirteen of 30 consecutive patients with hilar cholangiocarcinoma who underwent surgery, excluding 17 patients who underwent biliary drainage or preoperative portal embolization, were retrospectively evaluated. Using MDCT systems of 4 detector rows or 16 detector rows, plain and dynamic contrast-enhanced images of three phases were obtained. Extent of tumor spread and lymph node metastasis were assessed with MDCT and compared with histopathological findings.
The Bismuth-Corlette classification of hilar cholangiocarcinoma with MDCT were type I, 1 patient; type IIIa, 3 patients; type IIIb, 4 patients; and type IV, 5 patients; those with histopathological findings were type I, 1 patient; type IIIa, 2 patients; type IIIb, 4 patients; and type IV, 6 patients. One patient diagnosed as type IIIa with MDCT was pathologically diagnosed as type IV. Accuracy of MDCT in tumoral spread was 92.3%, although that of lymph node metastasis was 54%.
MDCT is likely to play an important role in evaluation of focal lesion spread especially in intrapancreatic tumor invasion, although a greater number of cohort cases are necessary to clearly define its role.
我们的目的是研究多排螺旋计算机断层扫描（MDCT）对肝门部胆管癌局部肿瘤扩散术前评估的诊断可靠性。材料与方法：回顾性评估30例连续接受手术的肝门部胆管癌患者中的13例，排除17例接受胆管引流或术前门静脉栓塞的患者。使用4排或16排探测器的MDCT系统，获取三个期相的平扫和动态对比增强图像。用MDCT评估肿瘤扩散范围和淋巴结转移情况，并与组织病理学结果进行比较。
MDCT诊断的肝门部胆管癌Bismuth-Corlette分型为：I型1例；IIIa型3例；IIIb型4例；IV型5例；组织病理学结果为：I型1例；IIIa型2例；IIIb型4例；IV型6例。1例MDCT诊断为IIIa型的患者病理诊断为IV型。MDCT对肿瘤扩散的诊断准确率为92.3%，而对淋巴结转移的诊断准确率为54%。
MDCT在评估局灶性病变扩散尤其是胰腺内肿瘤侵犯方面可能发挥重要作用，尽管需要更多的队列病例来明确其作用。
