不同影像学检查方法对壶腹癌的诊断价值对比分析

Comparison and Evaluation of Different Imaging Methods on the Diagnosis of Ampullary Carcinoma

目的评价不同影像学检查方法诊断壶腹癌的价值。方法选取我院1993—2008年经手术及病理证实的264例壶腹癌患者,回顾性分析B超、CT、磁共振成像(MRI)、磁共振胰胆管造影(MRCP)、经内镜逆行胰胆管造影(ERCP)检查结果,并对比分析各自的诊断符合率。结果 B超、CT、MRI、MRCP、ERCP对壶腹癌的诊断符合率分别为33.6%(81/241)、52.6%(120/228)、48.8%(40/82)、42.2%(19/45)和79.5%(120/151)。各种影像学检查的诊断符合率比较,差异有统计学意义(P<0.01);ERCP的诊断符合率显著高于其他影像学检查方法,B超检查的诊断符合率显著低于CT检查,差异有统计学意义(P<0.05);CT、MRI、MRCP的诊断符合率比较,差异无统计学意义(P>0.05)。结论 B超检查虽准确性差,但简便、快捷,可作为诊断壶腹癌的首选影像学检查方法;CT的诊断符合率优于B超;MRI、MRCP的诊断符合率与CT相比无明显差异;ERCP是目前诊断壶腹癌准确性最高的影像学检查方法,但不作为首选的影像学检查方法。

Objective To evaluate the value of five imaging methods in the diagnosis of ampullary carcinoma.Methods Clinicopathologic data like BUS,CT,MRI,MRCP and ERCP of 264 patients with ampullary carcinomas confirmed by operation and pathology between January 1993 and December 2008 were retrospectively reviewed.Retrospective comparative studies on the diagnostic value of BUS,CT,MRI,MRCP and ERCP were initiated.Results The diagnose accordance rates of BUS,CT,MRI,MRCP,ERCP in detecting ampullary carcinoma were 33.6%（81/241）,52.6%（120/228）,48.8%（40/82）,42.2%（19/45） and 79.5%（120/151）,respectively.The difference between each imaging method was significant（P0.05）.ERCP had a significantly higher diagnose accordance rate than other imaging methods（P0.05）.The diagnose accordance rate between CT and BUS had statistical difference（P0.05）.No significant differences were shown in diagnose accordance rate between CT,MRI and MRCP（P0.05）.Conclusion Each imaging methods has its advantages and disadvantages,it should be used rationally.BUS has lowest correctness for discovering ampullary carcinoma,but as a safe,quick and non-invasive examinational method,it may be the first choice for the diagnosis of ampullary carcinoma.CT had a much better diagnose accordance rate than BUS.No significant differences in diagnose accordance rate were found between CT,MRI and MRCP.ERCP is the most accurate method in the diagnosis of ampullary carcinoma,but it should not be used as a first-choice examination.