CT动态增强扫描在胆囊癌诊断和鉴别诊断中应用［摘要］目的分析CT动态增强扫描在胆囊癌的诊断与鉴别中的作用，为临床治疗提供参考。方法收集2007年6月〜2012年6月浙江省衢州柯城区人民医院和浙江大学医学院附属第一医院治疗的47例胆囊癌患者临床资料，对经病理证实的患者进行CT多期增强扫描，分析CT增强表现。结果在47例胆囊癌中，有43例显示出较中心区域更快的边缘强化，而胆囊息肉的患者未表现出上述强化方式；经过分析后，良、恶性肿瘤边缘-中心强化速度比差异有统计学意义(t=4.327,P0.05)o47例胆囊癌增强扫描表现为：①增厚型15例，增强后可见强化均匀。②结节型21例，增强后明显均匀强化，门脉期和延迟期结节持续强化。③肿块型7例，增强后呈不均匀强化，以周边强化更为明显,其中动脉期较其他各期表现更明显。④混合型4例，增强后病灶中心轻度强化，边缘中度以上强化。结论CT动态增强扫描具有良好的分辨率，明显的肿瘤影像特征，对胆囊癌的诊断、治疗和预后具有重要的参考价值。［关键词］胆囊癌；CT；增强；诊断［中图分类号］R735.8［文献标识码］A［文章编号］1673-7210(2013)11(c)-0114-03ApplicationofCTdynamicenhancedseanningingallbladderdiagnosisanddifferentialdiagnosisZHENGZhongqinlXUYanlXUGuoqiang21.DepartmentofRadiology,KechengDistrictPeople，sHospitalofQuzhou,ZhejiangProvince,Quzhou324000,China；2.DepartmentofDigestiveMedicine,theFirstHospitalAffiliatedtoSchoolofMedicineofZhejiangUniversity,ZhejiangProvince,Hangzhou310003,China[Abstract]ObjectiveToanalyzetheroleofdynamicenhancedCTscanninginthediagnosisandidentifiicationofgallbladdercarcinoma,andtoprovidereferenceforclinicaltreatmentofgallbladdercarcinoma・MethodsClinicaldataof47casesofpatientswithgallbladdercarcinomatreatedinKechengDistrictPeople，sHospitalofQuzhouandtheFirstHospitalAffiliatedtoSchoolofMedicineofZhejiangUniversityfTomJune2007toJune2012,thepatientsconfirmedbypathologyweresubjectedtomutiperiodicenhancedCTseanning,andCTenhancedperformanceanalyzed.ResuIts43casesofpatientsamong47casesofpatientswithgallbladdercarcinomashowedafasteredgeenhancementwhenthosewerecomparedinthecentralzone,andgallbladderpolyppatientsdidnotshowthatenhancedmethod；afteranalysis,benignormalignanttumoredge-centeralstrengthedvelocityratiowasstatisticallydifference(t=4.327,P0.05).47casesofgallbladdercarcinomaenhancedscanningsshowedasfollowing：①15casesofgallbladdercarcinomaswerefound,theunformenhancementofgallbladdercarcinomawasvisible・②21casesofgallbladdercarcinomasshowednodulartype,obvioushomogeneousenhancementwasavailableafterbeingintensified,nodulesduringtheportaiphaseanddelayperiodcontinuallystrengthened.③7casesofpatientsoflumptypes,unevenenhancementwasshownafterintensifying,perimeterreinforcementwasmoreapparent,inwhichtheperformanceofarterialphasewasmoreobviousthanthatinotherstages.④4casesofmixed,lesionscenterwasmildlystrengthedaftertheenhancement,theedgewasreinforcedmoderatelyandmoreviolently.ConclusionDynamicenhaneedCTscanningisprovidedclearresolutioandobvioustumorimagingfea.tures,imposingimportantreferencevalueonthediagnosis,treatmentandprognosisofthegallbladdercarcinoma・[Keywords]Gallbladdercarcinoma；Computedtomography(CT)；Enhancement；Diagnosis胆囊癌是临床上常见的恶性肿瘤，发病率居消化道肿瘤第5位［1］。由于胆囊癌无特异性症状，发病隐匿，给早期诊断带来一定困难。研究发现［2］,早期胆囊癌并手术，5年生存率达到98%,因此提前诊断，并进行针对性治疗，可以降低胆囊癌患者的死亡率，提高患者生存期。CT动态增强扫描的原理与MR动态扫描相似，其对早期发现各种类型胆囊癌有独特优势。本研究通过对经病理证实的47例胆囊...