容积CT阴性法胆道成像在胆道梗阻性病变中的应用研究

发布时间：2018-05-06 12:41

本文选题：胆道梗阻 + 容积CT　；参考：《山西医科大学》2013年硕士论文

【摘要】：【目的】通过分析良、恶性胆道梗阻性疾病的影像学特点,探讨阴性法胆道成像(negat i ve CT chol angi ogr aphy N-CTC)技术对胆道梗阻定位、定性的诊断价值,为N-CTC的临床应用提供较为可靠的理论依据。【材料与方法】收集我院2008年7月至2012年12月经临床手术病理证实或经ERCP活检取得病理的胆道梗阻患者47例,男29例,女18例,年龄12～87岁,平均59.6岁。所有患者均以黄疸或疼痛就诊,其中34例为无痛性黄疸,11例腹部疼痛伴黄疸,2例疼痛但不伴黄疸。发现黄疸时间1天～2周,具体情况见表1。所有患者于检查前均需进行胃肠道准备,其中30例通过饮水充盈消化道,17例口服阳性对比剂充盈消化道,要求在10～20分钟内饮1000ml,同时肌注6.542注射液10毫克,10分钟后再行64排螺旋CT平扫及增强扫描,并将所有原始图像传入Vi t ea2.0工作站进行三维重组,利用门静脉期图像获得N-CTC图像,根据需要进行冠状位、矢状位及斜位等多平面重组(multi-planar r ef or rrat i on, IVPR)和曲面重组(curved-planar ref or rrat i on, CPR)图像,所有重组图像重组层厚为1m，，重组间隔为0.5mm, 47例患者中有25例行磁共振胰胆管成像(IVR-chol angi opancr eat ogr aphy, IVRCP)扫描,然后由两位高年资诊断医师根据原始轴位图像、三维重组的N-CTC图像及IVRCP图像进行梗阻的定位和定性诊断,并与术后病理及ERCP诊断进行比较。计算N-CTC、MRCP对胆道梗阻性疾病的诊断准确性的灵敏度、特异度及约登指数。【结果】64排螺旋CT N-CTC可以清晰显示良、恶性梗阻性疾病的特征性表现。47例胆道梗阻患者中：64排螺旋CT N-CTC及MRCP对良、恶性梗阻的定位诊断准确率均为100%N-CTC对良、恶性梗阻的定性诊断灵敏度和特异度分别为82.4%(14/17)和86.7%/(26/30),约登指数为0.691；而MRCP对良、恶性梗阻的定性诊断灵敏度和特异度分别为83.3%(5/6)和94.7%(18/19),约登指数为0.78。【结论】64排螺旋CT阴性法胆道成像是一种便捷、无创伤性检查方法,临床应用方便、可行,与横断面图像结合可显示胆管周围的解剖结构和毗邻关系,清晰地显示出胆道梗阻性疾病良恶性的CT特征,直观显示胆管病变,对胆道梗阻的定位和定性诊断均具有重要价值。
[Abstract]:[objective] to analyze the imaging features of benign and malignant biliary obstructive diseases and to explore the diagnostic value of negat i ve CT chol angi ogr aphy N-CTCCtechnique in the diagnosis of biliary obstruction. To provide a more reliable theoretical basis for the clinical application of N-CTC. [materials and methods] from July 2008 to December 2012, 47 patients with biliary obstruction, 29 males and 18 females, aged 1287 years (mean 59.6 years), were pathologically confirmed or pathologically obtained by ERCP biopsy in our hospital. All the patients were treated with jaundice or pain, of which 34 were painless jaundice, 11 patients with abdominal pain and jaundice, 2 patients with pain but not with jaundice. Jaundice was found in 1 day and 2 weeks, as shown in Table 1. All patients were required to prepare their gastrointestinal tract before examination, of which 30 cases were filled with digestive tract through drinking water and 17 cases were filled with oral positive contrast agent. We were asked to drink 1000ml within 10 ~ 20 minutes and 6.542 injection 10 mg / min. After 10 minutes, 64-slice spiral CT plain scan and enhanced scan were performed, and all the original images were transferred to Vi t ea2.0 workstation for 3D recombination. The N-CTC images were obtained by portal vein phase images. Coronal, sagittal and oblique multi-planar r ef or rrat i on, IVPR) and curved-planar ref or rrat i on, CPR) images were performed. Of the 47 patients, 25 underwent Mr cholangiopancreatography (Mr cholangiopancreatography) IVR-chol angi opancr eat ogr aphy, IVRCP) scan, and then two senior Diagnostics performed the localization and qualitative diagnosis of obstruction according to the original axial images, three-dimensional reconstructed N-CTC images and IVRCP images. And compared with postoperative pathology and ERCP diagnosis. The sensitivity, specificity and Jordan index of N-CTCMr MRCP in the diagnosis of biliary obstructive diseases were calculated. [results] 64-slice spiral CT N-CTC could clearly show the characteristic manifestations of benign and malignant obstructive diseases. In 47 patients with biliary obstruction, the accuracy of diagnosis of benign and malignant obstruction by N-CTC and MRCP was both 100%N-CTC versus benign. The sensitivity and specificity of qualitative diagnosis of malignant obstruction were 82.414 / 17) and 86.7 / 26 / 30, respectively, and the Jorden index was 0.691, while the sensitivity and specificity of MRCP in qualitative diagnosis of benign and malignant obstruction were 83.3 / 6 and 94.7 / 18 / 19, respectively, and the Jorden index was 0.78. [conclusion] 64-slice spiral CT negative cholangiography is a convenient, non-traumatic examination method. It is convenient and feasible in clinical application. Combined with cross-sectional images, the anatomical structure and adjacent relationship around the bile duct can be displayed. Clearly showing the CT features of benign and malignant biliary obstructive diseases and visualizing bile duct lesions are of great value for the location and qualitative diagnosis of biliary obstruction.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.5

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