改良64排SCT阴性法胰胆管成像对胆总管壶腹及周围病变的诊断价值
发布时间：2018-08-08 13:34
【摘要】：目的 通过比较改良N-CTCP与常规N-CTCP对胆总管壶腹及周围病变显示程度,提高胆总管壶腹及周围病变的CT显示能力,为临床提供更多的诊断基础。通过64排SCT阴性法胰胆管成像与MRCP的定位及定性诊断率比较,分析改良N-CTCP在胆总管壶腹及周围疾变的筛查、诊断中的应用价值。 方法 1.收集我院2012年4月-2013年3月期间,临床或其它影像怀疑为胆总管壶腹及周围病变的患者21例,同时行常规及改良CT增强扫描,对两次图像根据-下7项指标进行比较：(病灶本身、病灶邻近组织、十二指肠乳头、胆总管下段管壁、管腔、胰管的显示程度及十二指肠充盈程度),分析胆总管壶腹及周围病变的CT显示能力。 2.在病变获得清晰显示的基础上,将同时行改良N-CTCP和MRCP的胆总管壶腹及周围病变患者41例与手术病理和随访结果比较,分析两种影像手段的定性及定位诊断准确率。 结果 1.改良N-CTCP与常规N-CTCP病变显示比较 (1)改良N-CTCP中低张和侧卧(左侧太高约45度)可清楚的观察胆总管壶腹及其周围病变与十二指肠降段的关系(是否原发或受累)。 (2)改良N-CTCP中提高对比剂浓度和流速可提高胆总管下段癌病灶与周围组织的密度差,对观察病变及周围受累情况有重要意义。 (3)改良N-CTCP与常规N-CTCP病变显示效果评分均数对比,数据经SSPS13.0统计软件分析,存在统计学差异(P0.05),即改良N-CTCP对病变显示效果优于常规N-CTCP。 2.改良N-CTCP与MRCP诊断正确率比较41例均经随访或手术及病理组织学检查确诊,其中肿瘤及肿瘤样病变共29例,炎症性病变共7例,结石性梗阻5例：改良N-CTCP组及MRCP组定位均与病理结果一致,准确率均为100%(41/41)；改良N-CTCP和MRCP定性准确率分别为92.7%(38/41)和82.9%(34/41),改良N-CTCP准确率较MRCP高,经Wilocxon符号秩检验,P=0.279,(P0.05),即表明改良N-CTCP与MRCP定性准确率无统计学差异。肿瘤及肿瘤样病变29例,改良N-CTCP和MRCP定性准确率分别为93.1%(27/29)和86.2%(25/29),两者比较亦无统计学差异(P0.05),改良N-CTCP对炎症性病变诊断正确率高于MRCP, MRCP对结石诊断正确率高于改良N-CTCP,但由于样本量少,需要进一步扩大样本量继续研究。 结论 1.64排SCT阴性法胰胆管成像是一种简单、快速、无创伤性的检查手段,通过强大的图像后处理技术可从不同角度显示胆总管壶腹及周围病变的部位、形态、范围及其与周围结构的关系,可评估胆道扩张程度,并可判断病灶切除的可能性。 2.改良N-CTCP优于常规N-CTCP对胆总管壶腹及其周围病变的显示效果,能够更加清晰的显示病变及邻近组织,为图像的后处理提供了前期准备。 3.改良N-CTCP在胆总管壶腹及周围病变的定位及定性准确率与MRCP相当,并可以优势互补,均是对胆总管壶腹及周围病变相当有效的检查方法。 4.改良N-CTCP可以作为临床疑诊胆总管壶腹及周围病变的常规检查方法。
[Abstract]:objective
By comparing the display of ampullary ampulla and surrounding lesions of common bile duct with improved N-CTCP and conventional N-CTCP, improve the CT display ability of the ampulla of the common bile duct and the surrounding lesions, and provide more diagnostic basis for the clinical. The improved N-CTCP was analyzed by 64 rows of SCT negative cholangiopancreatography and the ratio of the location and qualitative diagnosis of MRCP to the ampullary and periampullary of the common bile duct. Screening of peri disease and the application value in diagnosis.
Method
1. we collected 21 cases of clinical or other imaging suspected of ampullary ampulla of common bile duct and surrounding lesions during March -2013 year of April 2012, and performed routine and modified CT enhanced scans and compared the two images according to the lower 7 indicators: the lesion itself, the adjacent tissue of the lesion, the duodenal papilla, the inferior duct wall of the common bile duct, the lumen, and the pancreatic duct The degree of display and the degree of duodenal filling were analyzed, and the CT display ability of the common bile duct ampulla and surrounding lesions was analyzed.
2. on the basis of a clear display of the lesions, 41 patients with ampullary and peripheral lesions of the common bile duct which were simultaneously modified with N-CTCP and MRCP were compared with the surgical pathology and follow-up results, and the accuracy of the qualitative and location diagnosis of the two imaging methods was analyzed.
Result
1. comparison of modified N-CTCP and conventional N-CTCP lesions
(1) the relationship between the ampullary ampulla of the common bile duct and the surrounding lesions of the common bile duct and the descending duodenal segment (whether primary or involvement) can be clearly observed in the modified N-CTCP middle low and lateral decubitus (too high about 45 degrees on the left side).
(2) improving the concentration and flow rate of the contrast agent in the improved N-CTCP can improve the density difference between the lesion of the lower segment of the common bile duct and the surrounding tissue, and it is of great significance to the observation of the lesions and the surrounding involvement.
(3) the scores of improved N-CTCP and conventional N-CTCP lesions were compared, and the data were analyzed by SSPS13.0 statistical software, and there was a statistical difference (P0.05). That is, the effect of improved N-CTCP was better than that of conventional N-CTCP..
2. the diagnostic accuracy of improved N-CTCP and MRCP were all confirmed by follow-up or operation and histopathological examination, including 29 cases of tumor and tumor like lesions, 7 cases of inflammatory lesions and 5 cases of stone obstruction: the modified N-CTCP group and MRCP group were all consistent with the pathological results, the accuracy rate was 100% (41/41), and the improved N-CTCP and MRCP were qualitative and accurate. The rate was 92.7% (38/41) and 82.9% (34/41), and the accuracy of improved N-CTCP was higher than that of MRCP. After Wilocxon symbol rank test, P=0.279, (P0.05), that was, there was no statistical difference between the improved N-CTCP and MRCP qualitative accuracy. 29 cases of tumor and tumor like lesions, 93.1% (27/29) and 86.2%, improved N-CTCP and MRCP, respectively. The diagnostic accuracy of improved N-CTCP for inflammatory lesions was higher than that of MRCP, and the correct rate of diagnosis of MRCP for stones was higher than that of modified N-CTCP (P0.05). However, there was a need to further expand the sample size for further study due to the small sample size.
conclusion
1.64 row SCT negative cholangiopancreatography is a simple, rapid, non traumatic examination. Through a powerful image post-processing technique, it can display the parts of the ampulla of the common bile duct and the surrounding lesions from different angles, the shape, the scope and the relationship with the surrounding structures, which can evaluate the extent of the biliary tract dilatation and determine the possibility of the resection of the lesions.
2. improved N-CTCP is better than conventional N-CTCP in displaying the ampullary ampulla of the common bile duct and its surrounding lesions. It can show the lesions and adjacent tissues more clearly, and provide early preparation for the post-processing of the image.
3. the localization and qualitative accuracy of modified N-CTCP in the ampullary ampulla and surrounding lesions of the common bile duct is equal to that of MRCP, and can complement each other. All of them are quite effective methods to examine the ampullary ampulla of the common bile duct and the surrounding lesions.
4. modified N-CTCP can be used as a routine examination method for suspected common bile duct ampulla and surrounding lesions.
【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
本文编号：2171939
[Abstract]:objective
By comparing the display of ampullary ampulla and surrounding lesions of common bile duct with improved N-CTCP and conventional N-CTCP, improve the CT display ability of the ampulla of the common bile duct and the surrounding lesions, and provide more diagnostic basis for the clinical. The improved N-CTCP was analyzed by 64 rows of SCT negative cholangiopancreatography and the ratio of the location and qualitative diagnosis of MRCP to the ampullary and periampullary of the common bile duct. Screening of peri disease and the application value in diagnosis.
Method
1. we collected 21 cases of clinical or other imaging suspected of ampullary ampulla of common bile duct and surrounding lesions during March -2013 year of April 2012, and performed routine and modified CT enhanced scans and compared the two images according to the lower 7 indicators: the lesion itself, the adjacent tissue of the lesion, the duodenal papilla, the inferior duct wall of the common bile duct, the lumen, and the pancreatic duct The degree of display and the degree of duodenal filling were analyzed, and the CT display ability of the common bile duct ampulla and surrounding lesions was analyzed.
2. on the basis of a clear display of the lesions, 41 patients with ampullary and peripheral lesions of the common bile duct which were simultaneously modified with N-CTCP and MRCP were compared with the surgical pathology and follow-up results, and the accuracy of the qualitative and location diagnosis of the two imaging methods was analyzed.
Result
1. comparison of modified N-CTCP and conventional N-CTCP lesions
(1) the relationship between the ampullary ampulla of the common bile duct and the surrounding lesions of the common bile duct and the descending duodenal segment (whether primary or involvement) can be clearly observed in the modified N-CTCP middle low and lateral decubitus (too high about 45 degrees on the left side).
(2) improving the concentration and flow rate of the contrast agent in the improved N-CTCP can improve the density difference between the lesion of the lower segment of the common bile duct and the surrounding tissue, and it is of great significance to the observation of the lesions and the surrounding involvement.
(3) the scores of improved N-CTCP and conventional N-CTCP lesions were compared, and the data were analyzed by SSPS13.0 statistical software, and there was a statistical difference (P0.05). That is, the effect of improved N-CTCP was better than that of conventional N-CTCP..
2. the diagnostic accuracy of improved N-CTCP and MRCP were all confirmed by follow-up or operation and histopathological examination, including 29 cases of tumor and tumor like lesions, 7 cases of inflammatory lesions and 5 cases of stone obstruction: the modified N-CTCP group and MRCP group were all consistent with the pathological results, the accuracy rate was 100% (41/41), and the improved N-CTCP and MRCP were qualitative and accurate. The rate was 92.7% (38/41) and 82.9% (34/41), and the accuracy of improved N-CTCP was higher than that of MRCP. After Wilocxon symbol rank test, P=0.279, (P0.05), that was, there was no statistical difference between the improved N-CTCP and MRCP qualitative accuracy. 29 cases of tumor and tumor like lesions, 93.1% (27/29) and 86.2%, improved N-CTCP and MRCP, respectively. The diagnostic accuracy of improved N-CTCP for inflammatory lesions was higher than that of MRCP, and the correct rate of diagnosis of MRCP for stones was higher than that of modified N-CTCP (P0.05). However, there was a need to further expand the sample size for further study due to the small sample size.
conclusion
1.64 row SCT negative cholangiopancreatography is a simple, rapid, non traumatic examination. Through a powerful image post-processing technique, it can display the parts of the ampulla of the common bile duct and the surrounding lesions from different angles, the shape, the scope and the relationship with the surrounding structures, which can evaluate the extent of the biliary tract dilatation and determine the possibility of the resection of the lesions.
2. improved N-CTCP is better than conventional N-CTCP in displaying the ampullary ampulla of the common bile duct and its surrounding lesions. It can show the lesions and adjacent tissues more clearly, and provide early preparation for the post-processing of the image.
3. the localization and qualitative accuracy of modified N-CTCP in the ampullary ampulla and surrounding lesions of the common bile duct is equal to that of MRCP, and can complement each other. All of them are quite effective methods to examine the ampullary ampulla of the common bile duct and the surrounding lesions.
4. modified N-CTCP can be used as a routine examination method for suspected common bile duct ampulla and surrounding lesions.
【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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