MSCT曲面重组阴性法胆管成像与MRCP对肝外胆管癌的诊断比较

Comparison of negative MSCT cholangiopancreatography with curved planar reconstruction and MR cholangiopancreatography in the diagnosis of extrahepatic cholangiocarcinoma

目的比较多层螺旋CT曲面重组(CPR)阴性法胆管成像与单次激发厚层投射磁共振胰胆管成像(MRCP)对肝外胆管癌(EHCC)的诊断价值及限度。方法回顾性分析33例肝外胆管癌患者,采用单次激发快速自旋回波(SSFSE)序列,行MRCP检查后,同期采用10mm层厚、层距,一次屏气下完成上腹部CT平扫及二期增强扫描,将门静脉期图像采用2.5mm层厚、1.25mm间距重叠50%重建,获得轴面源像(ASI),数据传输至诊断工作站,利用reformat重组软件,进行胆管多平面重组(MPR),获得冠状面、矢状面及任意斜面胆管图像,在MPR基础上,再沿胆管走行方向管腔中心划曲线,进行曲面重组(CPR),获得CPR胆管图像。结果CPR、MRCP成功率为100%;CPR、MRCP均对肝外胆管癌部位做出明确诊断,定位诊断率为100%,定性诊断率分别为97%(32/33)和90.9%(30/33);对合并症的诊断率分别为100%和62.5%(10/16)。结论CPR、MRCP对肝外胆管癌均能明确定位;CPR对肝外胆管癌的定性诊断率高于MRCP,显示肝外胆管癌与扩张胆管的关系更直观;CPR对合并症的诊断率明显高于MRCP;CPR在肝外胆管癌的诊断中具有独特的优越性。

Objective To compare the diagnostic value of negative multislice spiral CT cholangiopancreatography with curved planar reconstruction （CPR） and magnetic resonance cholangiopancreatography （MRCP） for extrahepatic cholangiocarcinoma （EHCC）. Methods MRCP using single-shot fast spin echo （SSFSE） sequences was performed in 33 cases with EHCC. After MRCP examinations, CT scanning was performed with a 10 mm collimation thickness and interval. The row data of portal venous phase （PVP） was first reconstructed to bring out axial source images （ASI） with a 2.5 mm collimation thickness and 1.25 mm reconstruction interval. The ASI data was conveyed to workstation for CPR. Results The successful rate of CPR and MRCP was 100%. CPR and MRCP diagnosed the location of EHCC accurately. The locating accuracy for CPR and MRCP was 100%. The qualitative accuracy of CPR and MRCP was 97%（32/33） and 90.9%（30/33） respectively. The diagnostic accuracy of CPR and MRCP was 100% and 62.5%（10/16） respectively for complications. Conclusion CPR and MRCP can define the site of EHCC accurately. CPR is more accurate in identifying the quality and diagnosing the complications than MRCP. CPR is more unambiguous on showing the relation of EHCC and dilated bile ducts. CPR has particular advantage for the diagnosis of EHCC.