目的探讨胆总管梗阻性疾病的MSCT表现特征与诊断价值。方法对47例经手术或病理证实的胆总管梗阻性病症进行回顾性分析,包括胰头及壶腹部肿瘤23例(胰头癌18例,Vater’s壶腹癌2例,胆总管癌3例),胆总管结石20例,胆总管炎性狭窄4例。分析其CT表现,并与手术或病理对照。结果⑴胰头及壶腹部肿瘤表现为胰头增大变形及低密度区;胰头周围组织侵犯;扩张的胆总管突然中断;“双管征”;肝内胆管软藤状中、重度扩张;十二指肠内侧壁结节;胆总管壁增厚或下端结节;淋巴结转移和血行转移。⑵胆总管结石表现为胆管内环形或圆形致密影;“靶征”或“新月征”;梗阻以上胆总管轻度扩张。⑶胆总管炎性狭窄表现为梗阻端扩张胆总管逐渐变细,范围较长呈鼠尾巴状;梗阻以上胆管轻度扩张;胆管积气。结论多层螺旋CT对胆总管梗阻性疾病定位诊断准确,也具有较高的特异性,是一种安全快捷的检查方法,能为胆总管梗阻的诊断提供可靠的依据。尤其是多层螺旋CT的多平面重建技术(MPR)与曲面重建(CPR)技术在胆管成像上的应用,能直观地显示肝外胆管的走行、胆管及其周围病变与扩张胆管的关系。 Objective To investigate the features and diagnostic value of MSCT in the diagnosis of common bile duct obstruction. Methods Totally 47 cases of choledocholical obstruction confirmed by surgery or pathology were retrospectively analyzed, including 23 cases of pancreatic head and ampulla tumor (18 cases of pancreatic head carcinoma, 2 cases of Vater’s ampullary carcinoma and 3 cases of common bile duct carcinoma) Common bile duct stones in 20 cases, common bile duct inflammation in 4 cases. The CT findings were analyzed and compared with surgery or pathology. Results (1) The tumors in the pancreas and ampulla showed enlarged pancreas and low-density area; the tissue around the pancreas was inflated; the common bile duct was suddenly interrupted; the “double-tube sign” Dilatation; duodenal medial wall nodules; common bile duct wall thickening or lower nodules; lymph node metastasis and hematogenous metastasis. Â’¡ common bile duct stones showed intracranial or circular bile duct tight shadow; “target sign ” or “crescent sign ”; mild dilatation of the common bile duct obstruction. Â’¶ common bile duct stenosis showed obstruction expansion of the common bile duct dilatation, a long tail was rat-like; obstruction above the mild expansion of the bile duct; bile duct gas. Conclusion Multislice spiral CT is a safe and rapid method for the diagnosis of common bile duct obstruction. It can provide a reliable basis for the diagnosis of common bile duct obstruction. In particular, the application of multiplanar reconstruction (MPR) and surface reconstruction (CPR) techniques in multi-slice spiral CT in bile duct imaging can intuitively show the relationship between the extrahepatic bile duct pathology, the bile duct and its surrounding lesions and the expansion of the bile duct.