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目的探讨肝外胆管细胞癌所致胆系扩张的肝实质一过性密度差异(transient hepatic parenchymal attenuation differences,THAD)的影像学表现。资料与方法56例肝外胆管细胞癌致胆系扩张患者行肝脏三期动态扫描均可见THAD。分析THAD的影像学特征及THAD与胆系扩张程度的相关性。结果 56例共测量肝内胆管222段,其中轻度扩张46段,中度扩张98段,重度扩张78段。柱状或分枝状THAD(Ⅰ型)在胆管轻度扩张肝段的发生率明显低于胆管中、重度扩张肝段(χ2=186.68,P<0.005)。肝内胆管重度扩张时,扩张程度呈扇形或不规则片状THAD(Ⅱ型)发生率明显增高(t’=5.16,P<0.05)。Ⅱ型THAD阳性组95%可信区间下限为9.3 mm。Ⅲ型THAD阳性组与阴性组胆囊横径均数存在差异,其差异具有统计学意义(t’=6.46,P<0.05)。Ⅲ型THAD阳性组胆囊横径均数95%可信区间下限为28.2 mm。结论肝外胆管细胞癌所致胆系扩张的THAD的影像学表现主要有3种:(1)Ⅰ型。沿胆管分布的柱状或分枝状THAD,边界不清,肝内胆系扩张>5 mm时常见;(2)Ⅱ型。扇形或不规则片状THAD,边界清楚或不清楚,肝内胆系扩张>9.3 mm时常见;(3)Ⅲ型。胆囊旁肝实质内弧形片状THAD,边界不清,胆囊横径>28.2 mm时常见。
Objective To investigate the imaging findings of transhepatic hepatic parenchymal attenuation differences (THAD) in extrahepatic cholangiocarcinoma. Materials and Methods 56 cases of extrahepatic bile duct cell carcinoma caused by gallbladder dilatation patients underwent liver three phase dynamic scanning can be seen THAD. The imaging features of THAD and the correlation between THAD and dilatation of biliary tract were analyzed. Results A total of 222 segments of intrahepatic bile duct were measured in 56 cases, of which 46 segments were slightly expanded, 98 moderately expanded, and 78 severely expanded. The incidence of columnar or branched THAD (type Ⅰ) in the mildly expanded bile duct was significantly lower than that in the bile duct (χ2 = 186.68, P <0.005). Severe dilatation of the intrahepatic bile duct, the degree of expansion was fan-shaped or irregular sheet THAD (Ⅱ type) was significantly higher incidence (t ’= 5.16, P <0.05). The lower 95% confidence interval for type II THAD-positive patients was 9.3 mm. There was a significant difference in mean Gallbladder diameter between THAD-positive group and negative group (t ’= 6.46, P <0.05). Type III THAD positive group gallbladder diameter mean 95% confidence interval lower limit of 28.2 mm. Conclusion There are three main imaging findings of THAD caused by extrahepatic cholangiocarcinoma: (1) type Ⅰ. Along the bile duct distribution of columnar or branched THAD, the boundary is unclear, intrahepatic biliary dilatation> 5 mm common; (2) Type II. Fan or irregular sheet THAD, the border is clear or unclear, intrahepatic gallbladder dilatation> 9.3 mm common; (3) Type Ⅲ. Gallbladder parenchyma within the arcuate lamellar THAD, the border is unclear, the gallbladder diameter> 28.2 mm is common.