饮水低张多层螺旋CT胆道成像的临床研究
发布时间：2018-07-26 15:44
【摘要】：背景胆道梗阻性疾病，是临床常见的疾病之一，其临床症状以黄疸、腹痛为主，患者多起病急，症状较严重。对于胆道梗阻性疾病，可选择的影像学检查方法多样。临床常用有创的检查方法为：经皮经肝穿刺胆道造影（PTC）以及经内窥镜逆行性胰胆管造影（ERCP）、静脉胆道造影（IVC）,无创的检查方法为：X线口服胆囊造影、B超、CT胆道成像（CTC）以及磁共振胰胆成像（MRCP）等。以上检查方法，各有利弊，临床可根据具体情况，加以选择或灵活组合运用。目前，此方面疾病的诊断，越来越依靠无创性影像学检查，而MSCT，因其价格便宜、检查方便、信息量大、适应症宽，成为临床医生在胆道疾病检查的重要手段。MSCT在胆道成像方面的检查，分为螺旋CT胆道成像（Spiral CT Cholangiography，SCTC）及阴性法螺旋CT胆道成像（negative MSCT Cholangiography N-CTC），阳性法胆道成像需要静脉注射或者口服胆系造影剂，在造影剂充盈胆系时进行扫描，利用含阳性造影剂的高密度胆系与周围低密度肝脏组织的密度差异，可以获得胆系的三维成像，但SCTC受血清胆红素影响较大，加上检查准备时间长，目前应用较少。阴性法CT胆道成像，是近年来快速发展起来的一种无创性胆道成像技术，原理为通过静脉注射非离子型碘对比剂，对胰腺、肝脏、胆管壁等实质脏器强化而胆道系统不排泄造影剂，从而使胆道系统呈现相对低密度而成像。目前此法对胆道梗阻性疾病的诊断价值日益得到认可。本研究中运用饮水低张下MSCT胆道成像方法，是以N-CTC为基础，在准备工作中要求患者分时段大量饮水，充盈十二指肠圈，扫描前15分钟臀部肌肉注射盐酸消旋山莨菪碱注射液（654-2），对十二指肠圈及壶腹部括约肌松弛，充分显示扩张的胆道系统，提供尽可能多的诊断信息，以达到方便诊断的目的。 CT检查对胆道梗阻性疾病的诊断意义重大，在定性、定位、术前分期、手术选择方式等方面有重要作用。如何合理、有效的利用CT检查，是临床及影像学医生的必要任务。目前我们使用的64排（128层）螺旋CT，扫描时间快，单位时间覆盖率高，可以一次屏气像完成胸腹部扫描，，采集信息多，图像伪影少，扫描及重建层厚变薄，层厚可达到0.625mm，同时拥有强大的三维后处理技术，可以达到各向同性要求，目前后处理工作站上提供多平面重建（multi planner-reconstruction，MPR）、曲面重建（curved planar reformation，CPR）、容积重建（volume rendering，VR）以及最小密度投影（minimum intensity projection，MinIP）等重建技术，这些技术的应用，改变传统的CT以轴位观察为主的模式，提供了立体的、多角度观察病变的方式，对胆道疾病的早期诊断、鉴别诊断以及定位、定性诊断大有帮助。本研究第一部分收集病例对饮水低张下MSCT与非饮水低张MSCT在胆道梗阻性疾病的定位、定性方面进行对照性研究；第二部分对MPR、CPR、MinIP三种三维重建方法在胆道梗阻性疾病的应用进行比较分析，探讨其应用价值；第三部分对良、恶性胆道病变在饮水低张下MSCT的影像学特征进行分析，在胆道梗阻疾病的CT诊断与鉴别诊断方面进行研究。第四部分对既行饮水低张MSCT检查，又做磁共振MRCP的患者资料进行分析，对MSCT及MRCP对胆道梗阻患者定位、定性准确率进行比较。 研究一饮水低张MSCT胆道成像技术对胆道梗阻性疾病诊断的影响目的：探讨饮水低张MSCT技术在胆道梗阻性疾病成像的诊断价值。方法收集140例因梗阻性黄疸行MSCT胆道成像检查的患者，随机分为低张组与常规组两组，低张组70例行饮水低张下MSCT胆道成像；常规组70例常规MSCT胆道成像。两组影像学诊断结果与病理或ERCP结果对比，比较两组间在定位、定性诊断中的差异。结果低张组在胆道第3段定位准确性高于常规组（χ2=4.09,P0.05），低张组在恶性病变定性准确率高于常规组（χ2=6.73，P0.01）。结论饮水低张MSCT技术在低位、恶性胆道梗阻性疾病的诊断中，具有一定优势。 研究二三维重建技术在饮水低张MSCT胆道成像中的应用目的比较多种三维重建技术在胆道梗阻性疾病中的应用价值，探讨其应用价值方法三维重建方法为多平面重建法（MPR）、曲面重建法（CPR）、最小密度投影法（MinIP），对三种三维重建技术在胆道梗阻的应用价值进行分析。结果三种图像质量间秩和检验结果无明显差异。在满足诊断要求评分中三者秩和检验结果有统计学差异。三种重建方法单独诊断定性、定位诊断正确率最高的为MPR。结论三种三维重建方法中对胆道梗阻性疾病有较高应用价值的是MPR,合理选择和利用三维重建技术，是轴位图像的良好补充，能提供更多的诊断价值。 研究三良、恶性胆道梗阻疾病饮水低张MSCT表现分析目的分析胆道良、恶性疾病的表现在饮水低张MSCT，探索饮水低张MSCT在胆道疾病的诊断中的价值。方法对70例患者胆系扩张形态、程度以及梗阻端部位、形态进行统计分析结果肝内胆管扩张程度在两组间不具有统计学意义（p㧐0.05）；胆总管扩张程度在两组间具有统计学意义（P0.05），肝内胆管扩张形态两组间有统计学意义（P0.05）。梗阻端形态两组间有统计学意义（P0.05）。在梗阻部位两组间有统计学意义（P0.05），提示低位梗阻提示恶性可能。动态增强中，恶性肿瘤则因病理种类不同而表现各异。结论认真比较分析良、恶性胆道梗阻疾病的影像学特征，能提高MSCT诊断的准确率。 研究四饮水低张MSCT胆道成像与MRCP的对照研究目的对比饮水低张MSCT及MRCP在胆道梗阻性疾病诊断中的意义。方法对30例胆道梗阻性疾病患者的饮水低张MSCT及MRCP下的定位、定性准确率进行对照分析。结果两种检查方法的定性、定位准确率接近，无显著性差异。结论饮水低张MSCT是MRCP的良好替代和互补的检查方法。
[Abstract]:Obstructive disease of the biliary tract is one of the common clinical diseases. The clinical symptoms are jaundice and abdominal pain. The patients have more acute and severe symptoms. There are a variety of selective imaging methods for biliary obstructive diseases. The commonly used invasive methods are percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde. Sexual cholangiopancreatography (ERCP), venous cholangiography (IVC), noninvasive examination methods: X-ray oral cholecystography, B-ultrasound, CT biliary tract imaging (CTC) and magnetic resonance cholangiopancreatography (MRCP). The above examination methods have advantages and disadvantages, and can be selected or flexibly combined according to specific conditions. At present, the diagnosis of this disease is becoming more and more dependent Non invasive imaging examination, and MSCT, because of its cheap price, convenient inspection, large amount of information and wide adaptation, it has become an important means of biliary tract disease examination by clinicians,.MSCT in biliary tract imaging (Spiral CT Cholangiography, SCTC) and negative spiral CT biliary tract imaging (negative MSCT Cholangiog). Raphy N-CTC), the positive method of biliary tract imaging requires intravenous or oral cholangiopaniography, scanning when the contrast agent fills the bile system. The three-dimensional imaging of the biliary system can be obtained by using the density difference between the high density biliary system containing the positive contrast medium and the surrounding low density liver tissue, but the SCTC is influenced greatly by the serum bilirubin, plus the examination preparation. The negative method of CT biliary tract imaging is a noninvasive biliary tract imaging technique which has been developed rapidly in recent years. The principle is to strengthen the pancreas, liver and bile duct wall by intravenous injection of non ionic iodine contrast agent and do not excretion contrast agent in the biliary tract system, so that the biliary system is relatively low density. Imaging. The diagnostic value of this method is increasingly recognized in the diagnosis of biliary obstructive diseases. In this study, the low tension MSCT method of drinking water in this study is based on N-CTC, which requires a large amount of drinking water, filling the duodenum, and intramuscular injection of Raceanisodamine Hydrochloride Injection (65) in the first 15 minutes of the preparatory work. 4-2) provide adequate diagnostic information for the relaxation of the duodenal and ampullary sphincter muscles, fully displaying the dilated biliary tract system, so as to facilitate the diagnosis.
CT examination is of great significance in diagnosis of biliary obstructive diseases. It plays an important role in qualitative, location, preoperative staging, and surgical selection. It is a necessary task for clinical and imaging doctors how to rationally and effectively use CT examination. At present, the 64 row (128 layer) spiral CT we use is fast scanning time and high coverage per unit time. One breath hold the chest and abdomen scan, with more information, less image artifact, thinner thickness of scanning and reconstruction layer, and the thickness of layer can reach 0.625mm. At the same time, it has a powerful 3D post-processing technology, which can meet the isotropic requirement. At present, the post processing workstation provides multi planner-reconstruction, MPR, surface reconstruction (curved PL). ANAR reformation, CPR), volume reconstruction (volume rendering, VR), and minimum density projection (minimum intensity projection, MinIP), such as minimum intensity projection, MinIP, are used to change the traditional mode of CT with axial observation, providing a stereoscopic, multi angle observation of the disease, early diagnosis and differential diagnosis of biliary diseases. The first part of this study collected cases on the location of MSCT and non drinking low tension MSCT in the obstructive diseases of the biliary tract, and made a comparative study on the qualitative aspects. The second part was to compare and analyze the application of the three three-dimensional reconstruction methods of MPR, CPR and MinIP in the biliary tract obstruction disease. The third part of the third part is the analysis of the imaging features of the benign and malignant biliary tract lesions under the low tension of drinking water, the CT diagnosis and differential diagnosis of the biliary obstruction disease. The fourth part is the analysis of the patients with the low tension MSCT of drinking water and the data of the MRI MRCP, and the determination of MSCT and MRCP to the patients with biliary obstruction. Position, qualitative accuracy rate is compared.
The purpose of this study was to investigate the effect of drinking water low MSCT biliary tract imaging on the diagnosis of biliary obstructive diseases: To explore the diagnostic value of low tension MSCT technique in the diagnosis of biliary obstructive diseases. Methods 140 patients with obstructive jaundice with MSCT biliary tract imaging were randomly divided into two groups of low tension group and routine group, and 70 cases in low tension group were drinking water. Low tension MSCT biliary tract imaging; routine group 70 cases of routine MSCT biliary tract imaging. The two groups of imaging diagnosis results were compared with pathological or ERCP results, and the differences between the two groups were compared in the location and qualitative diagnosis. Results the accuracy of the third segments in the biliary tract was higher than that of the conventional group (x 2=4.09, P0.05), and the qualitative accuracy rate of the low tension group was higher than that of the normal group. Regulation group (x 2=6.73, P0.01). Conclusion drinking water hypotonic MSCT technology has certain advantages in the diagnosis of low level and malignant biliary obstructive disease.
Objective to study the application of two three-dimensional reconstruction technique in the low tension MSCT cholangio imaging of drinking water. Comparison of the application value of multiple three-dimensional reconstruction techniques in biliary obstructive diseases, the application value method of three-dimensional reconstruction method is multi plane reconstruction (MPR), surface reconstruction (CPR), minimum density projection (MinIP), and three three dimensional reconstruction techniques The application value of biliary obstruction was analyzed. Results there was no significant difference between the rank and test results of the three kinds of image quality. There was a statistical difference between the rank and test results of the three methods in meeting the diagnostic requirements. Three kinds of reconstruction methods were separately diagnosed and qualitative, and the highest correct rate of location diagnosis was MPR. conclusion in three three-dimensional reconstruction methods for biliary obstruction. It is MPR that has a high value in sexual diseases. Rational selection and utilization of three-dimensional reconstruction technology is a good complement to axial images and can provide more diagnostic value.
Analysis of the low tension MSCT manifestations of three good and malignant biliary obstruction diseases objective analysis of good bile duct and malignant disease in drinking water low MSCT, to explore the value of low tension MSCT in the diagnosis of biliary tract diseases. Methods 70 cases of biliary dilatation, degree and the end of the obstruction, morphology were statistically analyzed and the results of intrahepatic bile duct expansion were analyzed. Zhang Chengdu did not have statistical significance between the two groups (P? 0.05); the extent of choledochal dilatation was statistically significant between the two groups (P0.05), and there were statistical significance between the two groups of intrahepatic bile duct dilatation (P0.05). There were statistical significance between the two groups of the obstructive end form (P0.05). The lower obstruction was statistically significant (P0.05), suggesting low level obstruction. It is possible to show malignancy. In dynamic enhancement, the malignant tumor is different because of the different pathological types. Conclusion a careful comparison and analysis of the imaging features of benign and malignant biliary obstruction can improve the accuracy of MSCT diagnosis.
Study four the comparative study of low tension MSCT cholangiography and MRCP in drinking water objective to compare the significance of drinking water low tension MSCT and MRCP in the diagnosis of biliary obstructive diseases. Methods the location of low MSCT and MRCP of drinking water in 30 cases of biliary obstruction and the qualitative accuracy rate were compared. Results two kinds of examination methods were qualitatively and accurately located. Conclusion hypotonic MSCT in drinking water is a good alternative and complementary examination method for MRCP.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R816.5
本文编号：2146495
[Abstract]:Obstructive disease of the biliary tract is one of the common clinical diseases. The clinical symptoms are jaundice and abdominal pain. The patients have more acute and severe symptoms. There are a variety of selective imaging methods for biliary obstructive diseases. The commonly used invasive methods are percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde. Sexual cholangiopancreatography (ERCP), venous cholangiography (IVC), noninvasive examination methods: X-ray oral cholecystography, B-ultrasound, CT biliary tract imaging (CTC) and magnetic resonance cholangiopancreatography (MRCP). The above examination methods have advantages and disadvantages, and can be selected or flexibly combined according to specific conditions. At present, the diagnosis of this disease is becoming more and more dependent Non invasive imaging examination, and MSCT, because of its cheap price, convenient inspection, large amount of information and wide adaptation, it has become an important means of biliary tract disease examination by clinicians,.MSCT in biliary tract imaging (Spiral CT Cholangiography, SCTC) and negative spiral CT biliary tract imaging (negative MSCT Cholangiog). Raphy N-CTC), the positive method of biliary tract imaging requires intravenous or oral cholangiopaniography, scanning when the contrast agent fills the bile system. The three-dimensional imaging of the biliary system can be obtained by using the density difference between the high density biliary system containing the positive contrast medium and the surrounding low density liver tissue, but the SCTC is influenced greatly by the serum bilirubin, plus the examination preparation. The negative method of CT biliary tract imaging is a noninvasive biliary tract imaging technique which has been developed rapidly in recent years. The principle is to strengthen the pancreas, liver and bile duct wall by intravenous injection of non ionic iodine contrast agent and do not excretion contrast agent in the biliary tract system, so that the biliary system is relatively low density. Imaging. The diagnostic value of this method is increasingly recognized in the diagnosis of biliary obstructive diseases. In this study, the low tension MSCT method of drinking water in this study is based on N-CTC, which requires a large amount of drinking water, filling the duodenum, and intramuscular injection of Raceanisodamine Hydrochloride Injection (65) in the first 15 minutes of the preparatory work. 4-2) provide adequate diagnostic information for the relaxation of the duodenal and ampullary sphincter muscles, fully displaying the dilated biliary tract system, so as to facilitate the diagnosis.
CT examination is of great significance in diagnosis of biliary obstructive diseases. It plays an important role in qualitative, location, preoperative staging, and surgical selection. It is a necessary task for clinical and imaging doctors how to rationally and effectively use CT examination. At present, the 64 row (128 layer) spiral CT we use is fast scanning time and high coverage per unit time. One breath hold the chest and abdomen scan, with more information, less image artifact, thinner thickness of scanning and reconstruction layer, and the thickness of layer can reach 0.625mm. At the same time, it has a powerful 3D post-processing technology, which can meet the isotropic requirement. At present, the post processing workstation provides multi planner-reconstruction, MPR, surface reconstruction (curved PL). ANAR reformation, CPR), volume reconstruction (volume rendering, VR), and minimum density projection (minimum intensity projection, MinIP), such as minimum intensity projection, MinIP, are used to change the traditional mode of CT with axial observation, providing a stereoscopic, multi angle observation of the disease, early diagnosis and differential diagnosis of biliary diseases. The first part of this study collected cases on the location of MSCT and non drinking low tension MSCT in the obstructive diseases of the biliary tract, and made a comparative study on the qualitative aspects. The second part was to compare and analyze the application of the three three-dimensional reconstruction methods of MPR, CPR and MinIP in the biliary tract obstruction disease. The third part of the third part is the analysis of the imaging features of the benign and malignant biliary tract lesions under the low tension of drinking water, the CT diagnosis and differential diagnosis of the biliary obstruction disease. The fourth part is the analysis of the patients with the low tension MSCT of drinking water and the data of the MRI MRCP, and the determination of MSCT and MRCP to the patients with biliary obstruction. Position, qualitative accuracy rate is compared.
The purpose of this study was to investigate the effect of drinking water low MSCT biliary tract imaging on the diagnosis of biliary obstructive diseases: To explore the diagnostic value of low tension MSCT technique in the diagnosis of biliary obstructive diseases. Methods 140 patients with obstructive jaundice with MSCT biliary tract imaging were randomly divided into two groups of low tension group and routine group, and 70 cases in low tension group were drinking water. Low tension MSCT biliary tract imaging; routine group 70 cases of routine MSCT biliary tract imaging. The two groups of imaging diagnosis results were compared with pathological or ERCP results, and the differences between the two groups were compared in the location and qualitative diagnosis. Results the accuracy of the third segments in the biliary tract was higher than that of the conventional group (x 2=4.09, P0.05), and the qualitative accuracy rate of the low tension group was higher than that of the normal group. Regulation group (x 2=6.73, P0.01). Conclusion drinking water hypotonic MSCT technology has certain advantages in the diagnosis of low level and malignant biliary obstructive disease.
Objective to study the application of two three-dimensional reconstruction technique in the low tension MSCT cholangio imaging of drinking water. Comparison of the application value of multiple three-dimensional reconstruction techniques in biliary obstructive diseases, the application value method of three-dimensional reconstruction method is multi plane reconstruction (MPR), surface reconstruction (CPR), minimum density projection (MinIP), and three three dimensional reconstruction techniques The application value of biliary obstruction was analyzed. Results there was no significant difference between the rank and test results of the three kinds of image quality. There was a statistical difference between the rank and test results of the three methods in meeting the diagnostic requirements. Three kinds of reconstruction methods were separately diagnosed and qualitative, and the highest correct rate of location diagnosis was MPR. conclusion in three three-dimensional reconstruction methods for biliary obstruction. It is MPR that has a high value in sexual diseases. Rational selection and utilization of three-dimensional reconstruction technology is a good complement to axial images and can provide more diagnostic value.
Analysis of the low tension MSCT manifestations of three good and malignant biliary obstruction diseases objective analysis of good bile duct and malignant disease in drinking water low MSCT, to explore the value of low tension MSCT in the diagnosis of biliary tract diseases. Methods 70 cases of biliary dilatation, degree and the end of the obstruction, morphology were statistically analyzed and the results of intrahepatic bile duct expansion were analyzed. Zhang Chengdu did not have statistical significance between the two groups (P? 0.05); the extent of choledochal dilatation was statistically significant between the two groups (P0.05), and there were statistical significance between the two groups of intrahepatic bile duct dilatation (P0.05). There were statistical significance between the two groups of the obstructive end form (P0.05). The lower obstruction was statistically significant (P0.05), suggesting low level obstruction. It is possible to show malignancy. In dynamic enhancement, the malignant tumor is different because of the different pathological types. Conclusion a careful comparison and analysis of the imaging features of benign and malignant biliary obstruction can improve the accuracy of MSCT diagnosis.
Study four the comparative study of low tension MSCT cholangiography and MRCP in drinking water objective to compare the significance of drinking water low tension MSCT and MRCP in the diagnosis of biliary obstructive diseases. Methods the location of low MSCT and MRCP of drinking water in 30 cases of biliary obstruction and the qualitative accuracy rate were compared. Results two kinds of examination methods were qualitatively and accurately located. Conclusion hypotonic MSCT in drinking water is a good alternative and complementary examination method for MRCP.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R816.5
本文编号：2146495
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