CT、MRI及MRCP在恶性胆道梗阻中的诊断价值

Value of CT,MRI and MRCP in Diagnosis of Malignant Bile Duct Obstruction

目的：探讨CT、MRI和MRCP对恶性胆道梗阻的综合诊断价值。方法：搜集2000年9月～2007年9月经手术病理和临床治疗证实的胰胆管恶性肿瘤298例，包括肝内胆管癌13例，肝门胆管癌56例，胆总管癌34例，壶腹癌19例，胆囊癌20例，胰头癌156例。回顾性分析其CT、MRI及MRCP的表现。结果：全部患者MRCP检查均一次成功，胆管及胰管显示满意；MRCP对胆道梗阻定位符合率为94．3％，MRCP结合MRI定位符合率提高到100％；CT、MRI和MRCP对恶性胆道梗阻病变的定性诊断符合率分别为80．5％、84．2％和76．2％，MRI结合MRCP定性诊断符合率为89．6％。CT、MRI及MRCP定性诊断符合率提高至91．6％。结论：MRCP联合MRI能够提高恶性胆道梗阻的定位符合率，综合分析CT、MRI及MRCP表现能提高恶性胆道梗阻的定性诊断符合率。

Objective：To evaluate the ctinieal value of CT, MRI and MRCP in the diagnosis of malignant bile duet obstruction. Methods：Between september 2000 and september 2007,298 patients with clinical signs of malignant bile duet obstruction underwent CT.MRI and MRCP, including 13 cases of peripheral bile duet carcinoma, 56 cases of hilar bile duct carcinoma,34 cases of common bile duct carcinoma, 19 cases of ampulla carcinoma, 20 eases of gallbladder carcinoma and 156 cases of pancreas head carcinoma. Results：The images of MRCP were essentially identical to those of direct eholangiog- raphy. The accuracy of MRCP in evaluating the site of obstruction was 94.3 % ,and it could increase to 100 % in combination with MRI. The accuracies of CT.MRI and MRCP in evaluating the nature of obstruction were 80.5%、84.2% and 76.2~. The accuracy of MRCP with MRI in evaluating the nature of obstruction was 89.6%. The accuracy of CT combined with MRCP and MRI in evaluating the nature of obstruction was 91. 6%. Conclusion： Conventional MRI in combination with MRCP can increase the accuracy of diagnosis of location of the diseases. A comprehensive analysis of CT,MRI,MRCP features can increase the accuracy of diagnosis of nature of the diseases.