B超、CT与MRI诊断胆管结石的比较研究

Comparative study of ultrasonography, computed tomography and magnetic resonance imaging in diagnosing biliary stones

目的比较B超、CT与MRI各成像序列对胆管结石的诊断价值。方法23例临床拟诊胆管结石的患者行B超和MRI检查,其中10例行同期CT扫描。最后诊断均经手术或经内镜逆行胰胆管造影(ERCP)证实。依据影像诊断报告结果总结B超、CT与MRI诊断胆管结石的准确性,并通过回顾性分析CT与MRI脉冲序列图像探讨各种技术的优缺点。结果23例病人中,22例有胆管结石,1例手术中未见胆管内结石。B超诊断结石12例,其中1例假阳性,诊断准确度48%(11/23)。CT诊断结石8例,假阴性2例,诊断准确度80%(8/10)。MRI诊断结石20例,其中1例假阳性,诊断准确度83%(19/23)。在MRI各序列中,磁共振胰胆管造影(MRCP)显示胆管结石最直观,轴位T2WI与T1WI是MRCP的有益补充。结论诊断胆管结石时,B超可作为初步筛查方法。CT与MRI的诊断准确性较高,且后者多序列多方向的成像能力可补充B超与CT的不足。

Objective To compare the diagnostic value of ultrasonagraphy （ US）, computed tomography （CT） and magnetic resonance imaging （MRI） in showing biliary stones. Methods Twenty - three patients suspected of biliary stones underwent abdominal US and MRI. Ten of them performed CT examination at the same period. Final diagnosis was confirmed by surgery or endoscopic retrograde cholangiopancreatography （ERCP）, Results T here was stone in the bile duct in 22 and no stone in 1 of 23 patients, US indicated stones in 12 cases, 1 false positive result was among them, CT diagnosed stones in 8 cases and false negative result in 2 cases, MRI showed stones in 20 cases, and 1 of 20 had false positive result. The diagnostic accuracy of US, CT and MRI was 48% （ 11/23 ）, 80% （ 8/10 ） and 83% （ 19/23 ） respectively on the basis of records of imaging diagnostic reports. Conclusion US should be used as a primary screaning tool, CT and MRI are able to improve the diagnostic accuracy of biliary stones. MRI and CT are complementary in some cases.