Differentiating malignant from benign common bile duct stricture with multiphasic helical CT
Differentiating malignant from benign common bile duct stricture with multiphasic helical CT
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DOI：
10.1148/radiol.2361040792
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发表时间：
2005-07-01
期刊：
影响因子：
19.7
通讯作者：
Choi, BI
中科院分区：
文献类型：
--
作者：
Choi, SH;Han, JK;Choi, BI
目得：回顾性评价使用多相螺旋计算机断层扫描（CT）区分恶性和良性胆总管（CBD）狭窄的患者只有一个局灶性CBD狭窄，并确定这种differentiation.MATERIALS和METHODS预测：机构审查委员会的批准和知情同意，不需要。50例仅患有局灶性CBD狭窄的患者（35例男性，15例女性;年龄范围：35-87岁;平均年龄：61.6岁）构成了本研究的样本（32例恶性狭窄和18例良性狭窄）。所有恶性和5例良性CBD狭窄的诊断均通过回顾患者的手术和病理记录进行确认;在13例良性CBD狭窄中，诊断通过临床特征进行确认。分析多期CT表现，包括受累CBD的壁厚、位置、长度和强化模式，上游CBD直径和其他表现。通过单因素分析和多因素逐步Logistic回归分析比较CT特征对鉴别良恶性CBD狭窄的作用。恶性狭窄较长（17.9 mm +/- 6.6 [+/-标准差]）恶性病例的CBD上游直径（22.0 mm ± 5.4）大于良性病例（17.8 mm ± 4.6）（P = 0.033）。26例恶性肿瘤和3例良性肿瘤的瘤壁厚度均大于1.5mm（P <0.0001）。在肝动脉期和门静脉期，恶性病例（肝动脉期和门静脉期扫描分别为27例和30例）比良性病例（分别为2例和3例）更常观察到比正常CBD更大的增强（P < .0001）。多因素逐步Logistic回归分析结果显示，门静脉期受累CBD的高增强是唯一可独立鉴别良恶性狭窄的变量。结论：门静脉期受累CBD的高增强是鉴别良恶性狭窄的主要因素。(c)RSNA，2005年。
PURPOSE: To evaluate retrospectively the use of multiphasic helical computed tomography (CT) to differentiate malignant and benign common bile duct (CBD) strictures in patients with only a focal CBD stricture and to determine predictors for this differentiation.MATERIALS AND METHODS: Institutional review board approval and informed patient consent were not required. Fifty patients (35 men, 15 women; age range, 35-87 years; mean age, 61.6 years) with only a focal CBD stricture comprised the sample for this study (32 malignant and 18 benign strictures). The diagnosis of all malignant and five benign CBD strictures was confirmed by reviewing patients' surgical and pathology records; in 13 benign CBD strictures, the diagnosis was confirmed by means of clinical features. Multiphasic CT findings were analyzed with regard to the wall thickness, location, length, and enhancement pattern of the involved CBD, the upstream CBD diameter, and other findings. CT features to identify benign and malignant CBD strictures were compared by means of univariate analysis and multivariable stepwise logistic regression analysis.RESULTS: Malignant strictures were longer (17.9 mm +/- 6.6 [+/- standard deviation]) than benign strictures (8.9 mm 6.8) (P < .0001), and upstream CBD diameters were larger in malignant cases (22.0 mm 5.4) than in benign cases (17.8 mm 4.6) (P = .033). The involved wall thickness was more than 1.5 mm in 26 malignant cases and three benign cases (P < .0001). During both hepatic arterial and portal venous phases, greater enhancement than that in the normal CBD were more frequently observed in malignant cases (in 27 and 30 patients for hepatic arterial and portal venous phase scans, respectively) than in benign cases (in two and three patients, respectively) (P < .0001). Results of multivariable stepwise logistic regression analysis showed that hyperenhancement of the involved CBD during the portal venous phase was the only variable that could be used to independently differentiate malignant from benign strictures.CONCLUSION: Hyperenhancement of the involved CBD during the portal venous phase is the main factor distinguishing malignant from benign CBD strictures. (c) RSNA, 2005.