多层螺旋CT阴性法胰胆管成像与MRCP结合MRI诊断胆总管结石的对比分析

Comparison study on negative multislice spiral CT cholangiopancreatography and MR cholangiopancreatography combined with MRI in the diagnosis of choledocholithiasis

目的：探讨螺旋CT阴性法胰胆管成像（N-MSCTCP）对比MRCP结合MRI对胆总管结石的诊断价值。方法：收集临床疑诊胆道梗阻行腹部螺旋CT（MSCT）及MRCP检查的患者136例,MSCT扫描数据经后处理重建获得N-MSCTCP图像。两位医生采用盲法分别对N-MSCTCP及MRCP结合MRI图像作出梗阻定位及定性诊断。以ERCP及手术结果为标准,分别统计分析2种诊断方法对胆总管结石的诊断能力。结果：N-MSCTCP及MRCP结合MRI诊断方法诊断胆总管结石总的准确度分别为82.4%~84.6%和91.2%~92.6%。MRCP结合MRI检出胆总管微小结石阳性率明显高于N-MSCTCP（二者检出率分别为83.9%~87.1%和35.5%~45.2%）,差别有统计学意义（Fisher精确检验,P〈0.05）。两位阅片者间的诊断一致性很好（K〉0.75）。结论：对于胆总管结石N-MSCTCP与MRCP结合MRI均有较高的诊断准确度,而对于微小结石的检出MRCP结合MRI更有优势。

Objective：To compare the efficacy of negative multislice spiral CT cholangiopancreatography（N-MSCTCP） and MRCP combined with MRI in the diagnosis of choledocholithiasis.Methods：136 patients with clinically suspected obstruction of bile duct undergoing abdominal multislice spiral CT and MRCP were recruited in this study.N-MSCTCP was obtained by using reconstruction techniques.N-MSCTCP and MRCP images were reviewed independently by two experienced radiologists with blind methods,and the acquired results were compared with the final results.The diagnostic accuracy was calculated respectively.Results：The overall diagnotic accuracy in detecting choledocholithiasis for N-MSCTCP was 82.4%～84.6% and for MRCP combined with MRI was 91.2%～92.6%.MRCP combined with MRI had a higher accuracy in detecting the common bile duct micro-calculi than N-MSCTCP （the sensitivities were 83.9%～87.1% and 35.5%～45.2%,respectively）.Statistics showed significant differences in detecting micro-stones between the two methods（Fisher exact test,P0.05）.Interobserver agreement was excellent for N-MSCTCP and MRCP（K0.75）.Conclusion：N-MSCTCP and MRCP combined with MRI have high diagnostic accuracies in detecting common bile duct stones,but MRCP combined with MRI has a significantly high sensitivity for diagnosing micro-calculi of the common bile duct.