Department of Hepato-Biliary-Pancreatic Surgery, Saitama Medical University, Saitama, Japan.
J Gastroenterol Hepatol. 2010 Apr;25(4):731-7. doi: 10.1111/j.1440-1746.2009.06113.x. Epub 2010 Jan 14.
The aim of this study was to investigate the diagnostic reliability of multidetector-row computed tomography (MDCT) for the evaluation of tumor spread in hilar cholangiocarcinoma.
Images obtained from a 16-detector row scanner of 22 patients were interpreted. The diagnostic accuracy of longitudinal ductal spread, vertical invasion (including hepatic parenchyma), and lymph node metastasis was assessed with reference to histopathological findings.
The location of the tumor was correctly diagnosed in 95% of cases (21/22), but in five of these cases, the cut end of the intrahepatic bile duct was positive, resulting in 77% diagnostic accuracy for longitudinal spread. Among the patients with a negative bile duct surgical margin, there was a significant difference in the measurement of tumor spread between MDCT and microscopic investigation (P < 0.001). For vertical invasion, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MDCT were 69%, 100%, 100%, and 69% for the liver parenchyma, respectively. The sensitivity, specificity, PPV, and NPV of MDCT for lymph node metastasis were 50%, 75%, 43%, and 80%, respectively.
The diagnostic accuracy of MDCT for tumor location and vertical invasion was satisfactory, but ductal spread was underestimated in comparison with microscopic measurements.
本研究旨在探讨多层螺旋 CT（MDCT）在评估肝门部胆管癌肿瘤扩散中的诊断可靠性。
对 22 例患者的 16 排 CT 图像进行解读。参考组织病理学结果，评估 MDCT 对胆管纵向扩散、垂直侵犯（包括肝实质）和淋巴结转移的诊断准确性。
95%（21/22）的病例准确诊断了肿瘤位置，但在其中 5 例中，肝内胆管的切端呈阳性，导致纵向扩散的诊断准确率为 77%。在胆管手术切缘阴性的患者中，MDCT 与显微镜检查测量的肿瘤扩散程度存在显著差异（P < 0.001）。对于垂直侵犯，MDCT 对肝实质的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 69%、100%、100%和 69%。MDCT 对淋巴结转移的敏感性、特异性、PPV 和 NPV 分别为 50%、75%、43%和 80%。
MDCT 对肿瘤位置和垂直侵犯的诊断准确性令人满意，但与显微镜测量相比，胆管扩散程度被低估。
