Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
J Surg Res. 2019 Mar;235:487-493. doi: 10.1016/j.jss.2018.10.045. Epub 2018 Nov 26.
This study aimed to demonstrate the diagnostic ability of 64-row multidetector computed tomography (64-row MDCT) for longitudinal superficial extension of distal cholangiocarcinoma (LSEDC).
Twenty-seven patients with distal cholangiocarcinoma (DC) underwent preoperative 64-row MDCT without drainage tubes. LSEDC was diagnosed using curved planar reconstruction images reconstructed from 64-row MDCT, which were compared with pathologic findings.
LSEDC was observed in 13 patients (48%). Ten patients (37%) had enhancing nonthickened bile ducts extending continuously from the main tumor (type 1). These coincided with pathologic findings of high-grade dysplasia (HGD) in 90.0% of cases; that is, a positive predictive value (9/10). Fourteen patients (52%) had only wall thickening of the main tumor with or without enhancement (type 2). Four patients with HGD in this group were difficult to diagnose. Three patients (11%) had enhancing nonthickened bile ducts not in continuity with the main tumor (type 3). This finding revealed an inflammatory change instead of a carcinoma in the pathologic findings. The sensitivity and specificity of detecting HGD were 75% and 93% on the liver side, 33% and 100% on the duodenal side, respectively. Four patients (67%) with HGD on the liver side were overdiagnosed, and one patient (17%) was underdiagnosed. Most of the patients overdiagnosed on the liver side (3/4 or 75%) had drainage tubes inserted before the MDCT.
For DC patients without drainage tubes, the 64-row MDCT technique may be useful for diagnosing HGD depicted as LSEDC on the liver side but not as useful on the duodenal side.
本研究旨在展示 64 排多层螺旋 CT（64 排 MDCT）对远端胆管癌（DC）纵向浅表延伸（LSEDC）的诊断能力。
27 例远端胆管癌（DC）患者术前接受 64 排 MDCT 检查，未放置引流管。LSEDC 的诊断采用 64 排 MDCT 曲面重建图像，并与病理结果进行比较。
13 例患者（48%）观察到 LSEDC。10 例患者（37%）表现为从主肿瘤连续延伸的强化非增厚胆管（1 型）。这些与高级别异型增生（HGD）的病理发现一致，即阳性预测值为 90.0%（9/10）；14 例患者（52%）仅表现为主肿瘤壁增厚，伴或不伴有强化（2 型）。在该组中，有 4 例 HGD 患者难以诊断。3 例患者（11%）表现为与主肿瘤不连续的强化非增厚胆管（3 型）。该发现提示病理检查为炎症改变而非癌。在肝侧，检测 HGD 的敏感度和特异度分别为 75%和 93%，在十二指肠侧分别为 33%和 100%。在肝侧有 HGD 的 4 例患者被过度诊断，1 例患者被漏诊。在肝侧被过度诊断的患者（3/4 或 75%）大多在 MDCT 检查前放置了引流管。
对于无引流管的 DC 患者，64 排 MDCT 技术可能有助于诊断肝侧表现为 LSEDC 的 HGD，但对十二指肠侧的诊断价值不大。
