Schulte S J, Baron R L, Teefey S A, Rohrmann C A, Freeny P C, Shuman W P, Foster M A
Department of Radiology, University Hospital, Seattle, WA 98195.
AJR Am J Roentgenol. 1990 Jan;154(1):79-85. doi: 10.2214/ajr.154.1.2104731.
Recent reports have described thickening and enhancement of the extrahepatic bile duct wall on CT scans obtained after administration of IV contrast material. We undertook this study to establish parameters for the normal thickness and enhancement of the bile duct wall on CT, and to develop a differential diagnosis for thickening of the duct wall. Routine CT examinations of 100 patients without biliary disease were evaluated prospectively. The common hepatic duct and common bile duct could be visualized in 66% and 82% of cases, respectively; the walls of these ducts could be separately discerned in 59% and 52%. The mean thickness of the duct wall was 1 mm, with a maximal thickness of 1.5 mm. Wall enhancement was similar to (51%), slightly greater than (44%), or markedly greater than (5%) the enhancement of adjacent pancreatic parenchyma. A review of records covering a 5-year period identified 52 patients in whom CT showed thickening of the bile duct wall (greater than or equal to 2 mm). These patients could be categorized by seven underlying diseases, and analysis of the CT scans revealed four general patterns of thickening. Focal, concentric wall thickening in the distal common bile duct was associated with pancreatitis, pancreatic cancer, and common bile duct stones; focal, eccentric thickening tended to occur with cholangiocarcinoma and sclerosing cholangitis. Diffuse, concentric thickening was seen with acute cholangitis; diffuse, eccentric thickening was associated with oriental cholangiohepatitis and sclerosing cholangitis. Thickening of greater than 5 mm was seen only with cholangiocarcinoma. Enhancement of the duct wall in these groups varied and was of no predictive value. In summary, the extrahepatic bile ducts can be visualized in the majority of patients, and the normal duct wall should be 1.5 mm or less in thickness. Contrast enhancement of the duct wall occurs in patients without biliary tract disease and alone is predictive not predictive of pathology. Pancreatitis, pancreatic cancer, common bile duct stones, cholangiocarcinoma, sclerosing cholangitis, acute cholangitis, and oriental cholangiohepatitis are associated with thickening of the duct wall.
近期报告描述了静脉注射造影剂后CT扫描显示肝外胆管壁增厚及强化的情况。我们开展这项研究以确定CT上胆管壁正常厚度及强化的参数，并对胆管壁增厚进行鉴别诊断。对100例无胆道疾病患者的常规CT检查进行前瞻性评估。肝总管和胆总管分别在66%和82%的病例中可被观察到；这些胆管的壁分别在59%和52%的病例中可被单独分辨。胆管壁的平均厚度为1mm，最大厚度为1.5mm。管壁强化与相邻胰腺实质强化相似（51%）、略高于（44%）或显著高于（5%）。回顾5年期间的记录，确定了52例CT显示胆管壁增厚（大于或等于2mm）的患者。这些患者可按七种基础疾病分类，对CT扫描分析显示出四种增厚的一般模式。胆总管远端局灶性、同心性壁增厚与胰腺炎、胰腺癌和胆总管结石有关；局灶性、偏心性增厚倾向于发生在胆管癌和硬化性胆管炎。弥漫性、同心性增厚见于急性胆管炎；弥漫性、偏心性增厚与东方型胆管肝炎和硬化性胆管炎有关。仅在胆管癌中可见大于5mm的增厚。这些组中胆管壁的强化各不相同，无预测价值。总之，大多数患者的肝外胆管可被观察到，正常胆管壁厚度应在1.5mm或以下。无胆道疾病患者的胆管壁也会出现强化，且强化本身并不能预测病理情况。胰腺炎、胰腺癌、胆总管结石、胆管癌、硬化性胆管炎、急性胆管炎和东方型胆管肝炎与胆管壁增厚有关。
