摘要
目的回顾性分析经手术病理证实的肝外胆管癌(EHCC)患者的多层螺旋CT(MSCT)影像特征,探讨其误诊及漏诊的原因。方法对77例术前行MSCT上腹部平扫及增强扫描、术后病理证实为EHCC的患者的图像进行分析,观察病变的形态、发生部位、长度、胆道梗阻程度。结果77例患者中,5例在MSCT检查前进行了胆道外科操作,因此在之后的研究中排除。余72例患者中,22例未能诊断EHCC,误、漏诊率为30.6%。浸润型EHCC和肿块型EHCC的误、漏诊率分别为56.3%、10.3%。肝门部EHCC、胆总管EHCC总的误、漏诊率分别为23.3%、35.7%;肿块型EHCC组中,发生于肝门部和胆总管的EHCC误、漏诊率分别为13.6%、5.9%;浸润型EHCC组中,发生于肝门部和胆总管的EHCC误、漏诊率分别为50.0%、58.3%。肿块型EHCC组中,<1.5 cm、1.5~2.0 cm、>2.0 cm的肿瘤误、漏诊率分别为16.7%、6.7%、11.1%;浸润型EHCC组中,<1.5 cm、1.5~2.0 cm、>2.0 cm的肿瘤误、漏诊率分别为66.7%、40.0%、60.0%。42例胆总管EHCC中,胆总管不扩张、胆总管轻度、中度、重度扩张患者的误、漏诊率分别为27.2%、62.5%、50.0%、20.0%。72例EHCC病例均伴有肝内胆管不同程度扩张,Ⅰ级胆管分支轻度、中度、重度扩张患者的误、漏诊率分别为33.3%、47.1%、25.0%;Ⅱ级胆管分支轻度、中度、重度扩张患者的误、漏诊率分别为57.1%、39.3%、15.6%。结论EHCC的误、漏诊与肿瘤的形态、Ⅱ级胆管分支的扩张程度有关,浸润型EHCC误、漏诊率高于肿块型EHCC,Ⅱ级胆管分支扩张越明显,误、漏诊率越低。EHCC的误、漏诊与肿瘤的长度、发生部位关系不大。MSCT检查前的胆道引流术等胆道外科操作明显影响EHCC的诊断准确率。
Objective To investigate the features of missed and misdiagnosed extrahepatic cholangiocarcinoma(EHCC)by Multi-slice spiral computed tomography(MSCT)retrospectively,and analyze the causes of missing and misdiagnosis of EHCC.Methods The images of 77 patients who underwent pre-operative MSCT upper abdominal plain and enhanced scan and pathologically confirmed extrahepatic cholangiocarcinoma were analyzed to observe the morphology,location,length,and degree of biliary obstruction.Results Surgical procedures were performed before the MSCT examinations in 5 cases,which were excluded in the subsequent study.Among the remaining 72 patients,22 cases failed to be diagnosed with EHCC,and the missed and misdiagnosis rate was 30.6%.The missed diagnosis rates ofinfiltrating EHCC and mass-forming EHCC were 56.3%and 10.0%respectively.The overall misdiagnosis rates of hilar EHCC and common bile duct EHCC were 23.3%and 35.7%.In the mass-forming EHCC group,the misdiagnosis rates of hilar EHCC and common bile duct EHCC were 13.6%and 5.9%,respectively.In the infiltrating EHCC group,the misdiagnosis rate between hilar EHCC and common bile duct EHCC were 50.0%and 58.3%,respectively.In the mass-forming EHCC group,the misdiagnosis rates of tumors<1.5 cm,1.5-2.0 cm,and>2.0 cm were 16.7%,6.7%,11.1%,respectively.In the infiltrating EHCC group,the missed diagnosis rates of tumors<1.5 cm,1.5-2.0 cm,and>2.0 cm were 66.7%,40.0%,60.0%,respectively.Among the 42 cases of common bile duct EHCC,the missing and misdiagnosis rates between patients without common bile duct dilation,mild,moderate and severe common bile duct dilation were 27.2%,62.5%,50.0%,20.0%,respectively.72 cases were associated with intrahepatic bile duct expansion.The missing and misdiagnosis rates of the patients with mild,moderate,severe expansion of primary intrahepatic bile duct were 33.3%,47.1%,25.0%,respectively.The missing and misdiagnosis rates of the patients with mild,moderate,severe expansion of secondary intrahepatic bile duct were 57.1%,39.3%,15.6%,respectively.Conclusion The missing and misdiagnosis rate of EHCC was related to tumor morphology and the degree of dilatation of secondary intrahepatic bile ducts.The missing and misdiagnosis rate of infiltrating EHCC is higher than that of mass-forming EHCC.The more extensive the secondary bile duct branch dilatation,the lower the rate of missed diagnosis.The misdiagnosis of EHCC has little relation with tumor size(length)and location.Surgical operations such as biliary drainage before MSCT examination significantly affect the diagnostic rate of EHCC.
作者
王晓宇
尚华
耿左军
冯平勇
戚诚
雷建明
尚娟
WANG Xiaoyu;SHANG Hua;GENG Zuojun(Department of Radiology,the Second Hospital of Hebei Medical University,Shijiazhuang,Hebei Province 050000,P.R.China)
出处
《临床放射学杂志》
CSCD
北大核心
2020年第3期487-492,共6页
Journal of Clinical Radiology
关键词
肝外胆管癌
多层螺旋CT
误诊
漏诊
肝内胆管扩张
Extrahepatic cholangiocarcinoma
MSCT
Misdiagnosed
Missed
Intrahepatic bile duct dilation
作者简介
通讯作者:尚华
