Objective To discuss the value of multi-slice spiral CT in the diagnosis of ampullary cancer. Methods The detailed CT data of 35 patients with ampullary cancer verified by surgeries or endoscopic retrograde cholangiopancreatography (ERCP) were retrospectively analyzed. Results (1) Direct CT signs of ampullary cancer: among the 35 patients, 30 cases were observed with descending duodenums, 28 cases with obstructions in the final section of choledoch, and 2 cases were of cup-muzzle shape. (2) Indirect CT signs of ampullary cancer: 26 cases were observed with "double duct sign" in the final section of choledoch, and 16 cases were observed with gallbladder enlargements. (3) There were irregular thickening of the intestinal wall in 8 cases, violation of pancreatic head and uncinate process in 11 cases, lymph node enlargement beside abdominal aorta in 6 cases, and liver metastasis in 5 cases. (4) Among the 35 patients, 30 cases were diagnosed correctly, one case were misdiagnosed as pancreatic cancer, two cases were misdiagnosed as choledocholithiasis, and two cases were misdiagnosed as inflammatory mass of ampulla.. Conclusion Multi-slice spiral CT can display the mass of ampullary cancer, identify the nature of the obstruction in the biliary passage, which has great value in the diagnosis of ampullary cancer.%目的 探讨壶腹部癌的多层螺旋CT诊断价值.方法 对35例有完整CT资料,经手术或胰胆管逆行造影(ERCP)活检病理证实的壶腹部癌进行回顾性分析.结果 (1)直接征象:35例中30例可见十二指肠降段,其中28例胆总管下段内软组织肿块可见“截断征”,2例呈“杯口征”.(2)间接征象:26例可见胆总管下段及胰管扩张呈“双管征”,胆囊扩大16例.(3)十二指肠近段扩张,肠管壁不规则增厚8例,胰头、钩突部侵犯11例,腹主动旁淋巴结增大6例,肝转移5例.(4) CT正确诊断30例,1例误诊为胰头癌；2例误诊为胆总管下段结石,2例误诊为壶腹部炎症包块.结论 多层螺旋CT能显示壶腹部癌的肿块,鉴别胆道梗阻的部位及性质,根据CT征象中的直接征象与间接征象,能明确诊断壶腹部癌.
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