CT 鉴别肝脏黏液性囊腺瘤/囊腺癌与单纯性胆管囊肿。

CT differentiation of mucin-producing cystic neoplasms of the liver from solitary bile duct cysts.

机构信息

1 Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, Korea.

出版信息

AJR Am J Roentgenol. 2014 Jan;202(1):83-91. doi: 10.2214/AJR.12.9170.

DOI:10.2214/AJR.12.9170

PMID:24370132

Abstract

OBJECTIVE

The purpose of this study was to identify the CT features required for differentiating mucin-producing cystic neoplasms of the liver (mucinous cystic neoplasms and cyst-forming intraductal papillary neoplasms of the bile duct) from solitary bile duct cysts.

MATERIALS AND METHODS

CT images of pathologically confirmed mucinous cystic neoplasms (n = 15), cyst-forming intraductal papillary neoplasms of the bile duct (n = 16), and solitary bile duct cysts (n = 31) were reviewed. Analysis of the CT findings included shape, presence of septa, location of septa (peripheral vs central), thickness of septa (thin vs thick), mosaic pattern, mural nodules, intracystic debris, calcification, upstream bile duct dilatation, downstream bile duct dilatation, and communication between a cystic lesion and the bile duct. The maximum size of a cystic lesion and the maximum size of the largest mural nodule were measured.

RESULTS

The presence of septa, central septa, mural nodules, upstream bile duct dilatation, and downstream bile duct dilatation were found to be significant CT findings for differentiating mucinous cystic neoplasms and cyst-forming intraductal papillary neoplasms of the bile duct from solitary bile duct cysts (p < 0.05 for each finding). When two of these five criteria were used in combination, the sensitivity and specificity for diagnosing mucin-producing cystic neoplasms and cyst-forming intraductal papillary neoplasms of the bile duct were 87% (27 of 31) and 87% (27 of 31), respectively. When two of these five criteria were used in combination, the sensitivity and specificity for diagnosing mucinous cystic neoplasms and cyst-forming intraductal papillary neoplasms of the bile duct were 87% (27 of 31) and 87% (27 of 31), respectively [corrected].

CONCLUSION

With the use of specific CT criteria, mucin-producing cystic neoplasms of the liver can be differentiated from solitary bile duct cysts with a high degree of accuracy.

摘要

目的

本研究旨在确定 CT 特征，以区分肝脏黏液性囊性肿瘤（黏液性囊腺瘤和胆管囊状乳头状肿瘤）与孤立性胆管囊肿。

材料与方法

回顾性分析经病理证实的黏液性囊腺瘤（n=15）、胆管囊状乳头状肿瘤（n=16）和孤立性胆管囊肿（n=31）的 CT 图像。分析 CT 表现包括形态、分隔存在、分隔位置（周围性与中央性）、分隔厚度（薄与厚）、镶嵌征、壁结节、腔内碎屑、钙化、上游胆管扩张、下游胆管扩张及囊性病变与胆管相通。测量囊性病变的最大径及最大壁结节的最大径。

结果

存在分隔、中央分隔、壁结节、上游胆管扩张和下游胆管扩张是鉴别黏液性囊腺瘤和胆管囊状乳头状肿瘤与孤立性胆管囊肿的重要 CT 表现（p<0.05）。当使用这五个标准中的两个进行联合诊断时，黏液性囊腺瘤和胆管囊状乳头状肿瘤的诊断敏感度和特异度分别为 87%（31 个中的 27 个）和 87%（31 个中的 27 个）。