Tillich M, Mischinger H J, Preisegger K H, Rabl H, Szolar D H
Department of Radiology, Karl-Franzens Medical School and University Hospital, Graz, Austria.
AJR Am J Roentgenol. 1998 Sep;171(3):651-8. doi: 10.2214/ajr.171.3.9725291.
The purpose of our study was to assess the potential of thin-section multiphasic helical CT in diagnosis and staging of hilar cholangiocarcinomas.
Identically collimated helical CT studies were performed before and during the hepatic artery dominant phase and during the portal vein dominant phase of contrast enhancement in 29 consecutive patients with proven hilar cholangiocarcinomas. Differences in attenuation between the tumor and the liver were calculated in each case by subtracting the average attenuation of the tumor from that of the liver. A four-point scale termed a "lesion conspicuity score" was used to determine rates of tumor detection. CT findings were correlated with surgically assessed extent of tumor, histologic findings, or both in all cases.
Ten (34%) of the 29 hilar cholangiocarcinomas were detected on unenhanced images. All hilar cholangiocarcinomas (100%) were seen on hepatic artery dominant phase scans, and 25 (86%) of 29 hilar cholangiocarcinomas were seen on portal vein dominant phase scans, regardless of the morphologic appearance. An infiltrating stenotic lesion was found in 17 (59%) of 29 patients, an exophytic hilar lesion was found in 11 patients (38%), and one patient (3%) had an intraluminal polypoid lesion. Mean differences in enhancement between infiltrating stenotic lesions and the liver were significantly greater on hepatic artery dominant phase scans (28 +/- 10 H) than on portal vein dominant phase scans (10 +/- 8 H), whereas the mean difference in enhancement between the exophytic lesions and the liver was statistically greater during the portal vein dominant phase (p < .01). Two of the hilar cholangiocarcinomas were resectable at surgery, and 18 were not. The overall accuracy of helical CT for assessing resectability was 60%. In 10 (56%) of 18 patients, unresectable disease was correctly diagnosed with helical CT (sensitivity, 56%). Eight (44%) of 18 patients considered to have resectable tumors with helical CT had unresectable tumors at surgery. A resectable tumor was correctly diagnosed in two patients with helical CT.
Multiphasic helical CT can be used to detect and classify hilar cholangiocarcinomas. However, the exact proximal tumor extent along bile ducts tends to be underestimated with helical CT; therefore, helical CT is inaccurate for determining resectability.
本研究的目的是评估薄层多期螺旋CT在肝门部胆管癌诊断及分期中的应用潜力。
对29例经证实的肝门部胆管癌患者在对比剂增强的肝动脉期、门静脉期进行相同准直的螺旋CT扫描。在每一病例中，通过从肝脏的平均衰减值中减去肿瘤的平均衰减值来计算肿瘤与肝脏之间的衰减差异。采用一种名为“病变显影评分”的四点量表来确定肿瘤的检出率。在所有病例中，将CT表现与手术评估的肿瘤范围、组织学表现或两者进行关联分析。
29例肝门部胆管癌中有10例（34%）在平扫图像上被检出。所有肝门部胆管癌（100%）在肝动脉期扫描中均可见，29例肝门部胆管癌中有25例（86%）在门静脉期扫描中可见，与形态学表现无关。29例患者中有17例（59%）发现浸润性狭窄病变，11例（38%）发现外生性肝门部病变，1例（3%）有腔内息肉样病变。浸润性狭窄病变与肝脏之间的强化平均差异在肝动脉期扫描中（28±10H）显著大于门静脉期扫描（10±8H），而外生性病变与肝脏之间的强化平均差异在门静脉期显著更大（p<0.01）。29例肝门部胆管癌中有2例在手术中可切除，18例不可切除。螺旋CT评估可切除性的总体准确率为60%。18例患者中有10例（56%）不可切除的病变被螺旋CT正确诊断（敏感性为56%）。螺旋CT认为可切除的18例患者中有8例（44%）在手术中发现肿瘤不可切除。螺旋CT正确诊断了2例可切除的肿瘤。
多期螺旋CT可用于检测和分类肝门部胆管癌。然而，沿胆管的肿瘤近端确切范围往往被螺旋CT低估；因此，螺旋CT在确定可切除性方面不准确。
