不同Todani分型小儿先天性胆总管囊肿CT表现

doi:10.3969/j.issn.1672-5069.2021.02.034

摘要/Abstract

摘要： 目的探讨CT术前检查诊断不同Todani分型小儿先天性胆总管囊肿(CCC)效能。方法 2013年1月～2020年6月我院收治的CCC患儿126例,入院后接受CT平扫和增强扫描。所有患儿接受外科手术治疗,以术后组织病理学诊断为金标准,判断术前CT检查诊断Todani分型的效能。结果在126例患儿中,术后组织病理学诊断先天性胆总管囊肿Todani Ⅰ型36例、Ⅱ型10例、Ⅲ型11例、Ⅳ型34例和Ⅴ型35例;术前CT发现Ⅰ型表现为囊肿处于肝门与胰头间,平扫呈现出水平样密度囊性肿块,且大小不一;Ⅱ型CT表现为胆总管外侧肌壁呈现出囊性低密度影,密度均匀、边缘光滑,胆囊与肝内胆管无异常表现;Ⅲ型CT表现为胆总管下端的十二指肠壁内段存在囊状扩张,胆囊与胆囊管无异常表现;Ⅳ型表现为肝内外胆管可见多个大小不等的低密度囊性扩张,密度均匀、囊壁光滑,胆囊无异常表现;Ⅴ型CT表现为囊肿位置处于肝内,平扫呈现出近水样密度,囊肿大小不一,存在中心点征;CT术前诊断CCC患儿Todani分型Ⅰ型的灵敏度为83.3%、特异度为93.3%、准确率为90.5%、阳性预测值为83.3%、阴性预测值为93.3%;CT诊断CCC患儿Todani分型Ⅱ型的灵敏度为50.0%、特异度为95.7%、准确率为92.1%、阳性预测值为50.0%、阴性预测值为95.7%;CT诊断CCC患儿Todani分型Ⅲ型的灵敏度为54.5%、特异度为93.9%、准确率为90.5%、阳性预测值为46.2%、阴性预测值为95.6%;CT诊断CCC患儿Todani分型Ⅳ型的灵敏度为85.3%、特异度为91.3%、准确率为89.7%、阳性预测值为78.4%、阴性预测值为94.3%;CT诊断CCC患儿Todani分型Ⅴ型的灵敏度为80.0%、特异度为97.8%、准确率为92.9%、阳性预测值为93.3%、阴性预测值为92.7%。结论不同Todani分型的CCC患儿CT表现各不相同,据此作出术前诊断有很大的临床应用价值。

关键词: 先天性胆总管囊肿, CT检查, Todani分型, 小儿

Abstract: Objective The aim of this study was to explore the CT imaging manifestation of congenital choledochal cysts (CCC) in children with different Todani classification.Methods 126 children with CCC admitted to our hospital between January 2013 and June 2020 were selected for the study. All children received plain CT scan and enhanced CT scan after admission, then, underwent surgical operation for CCC. The CT imaging manifestations were summarized and its diagnostic efficacy was estimated when the histopathological examination was done as the gold standard.Results Out of the 126 children with CCC, the postoperative histopathologic diagnosis found Todani Ⅰ in 36 cases, Ⅱ in 10 cases, Ⅲ in 11, Ⅳ in 34, and Ⅴ in 35 cases; the preoperative CT feature in Todani Ⅰ was different size of cysts or a cystic masses between the hilar area of liver and pancreatic head; in Todani Ⅱ, the CT showed the cystic low density and smooth edges of lateral wall of common bile duct, with gallbladder and intrahepatic bile duct normal; in Todani Ⅲ, the CT showed the lower part of common bile duct cystic dilatation, with gallbladder and gallbladder tube normal; in Todani Ⅳ, the CT demonstrated the low density of bile duct inside and outside the liver cystic dilatation in multiple sizes; in Todani Ⅴ, the CT found the cyst in the liver, almost watery density; the CT preoperatively diagnosed children with CCC Todani typeⅠ with the sensitivity (Se) of 83.3%, the specificity (Sp) of 93.3%, the accuracy (AC) of 90.5%, the positive predictive value (PPV) of 83.3%, and the negative predictive value (NPV) of 93.3%; in the diagnosis of Todani type Ⅱ, the Se, Sp, Ac, PPV and NPV were 50.0%, 95.7%, 92.1%, 50.0% and 95.7%; in the diagnosis of Todani type Ⅲ, the Se, Sp, Ac, PPV and NPV were 54.5%, 93.9%, 90.5%, 46.2% and 95.6%; in the diagnosis of Todani type Ⅳ, the Se, Sp, Ac, PPV and NPV were 85.3%, 91.3%, 89.7%, 78.4% and 94.3%; in the diagnosis of Todani type Ⅴ, the Se, Sp, Ac, PPV and NPV were 80.0%, 97.8%, 92.9%, 93.3% and 92.7%.Conclusion The CT manifestations of CCC in children with different Todani types are characteristic, which might help the preoperative diagnosis and dealing with it appropriately.

Key words: Congenital choledochal cyst, CT scan, Todani type, Children

韩啸, 郭万亮, 方林. 不同Todani分型小儿先天性胆总管囊肿CT表现[J]. 实用肝脏病杂志, 2021, 24(2): 284-287.

Han Xiao, Guo Wanliang, Fang Lin. CT imaging manifestation of congenital choledochal cysts in children with different Todani classification[J]. Journal of Practical Hepatology, 2021, 24(2): 284-287.

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