109例胆道结石超声与MRI诊断的对照研究

A comparative study of diagnosis of MRI and ultrasonography in 109 cases of biliary calculi

目的比较超声与磁共振成像(MRI)各成像序列对胆道结石的诊断价值。方法根据本院情况,抽取109例单纯胆道结石病例的术前超声与MRI资料。比较两种检查方法诊断胆道结石的准确率、灵敏度和特异度。结果 109例胆道系统结石病例中,术中所见24例为胆囊结石,32例为胆总管结石,7例为肝内胆管结石,46例有两个部位以上的结石同时存在。MRI和超声诊断胆囊结石的灵敏度、特异度和准确率分别为87.63%、99.17%、92.98%,94.01%、95.09%和94.73%;MRI和超声诊断胆总管结石的灵敏度、特异度和准确率分别为92.67%、97.33%、94.52%,76.44%、77.86%和76.71%;MRI和超声诊断肝内胆管结石的灵敏度、特异度和准确率分别为73.42%、84.82%、85.71%,75.31%、75.91%和75.00%。结论诊断胆道结石时,超声可作为初步筛查方法。与MRI结合才能提高诊断率,后者多序列多方向的成像能力可补充超声不足。在MRI与磁共振胰胆成像(MRCP)的各成像序列中,以T2WI、FIESTA冠位及MRCP原始图像结合观察为优。

Objective To compare the diagnostic value of ultrasonography and magnetic resonance imaging （MRI）in showing bili-ary calculi.Methods Totally 109 cases of biliary calculi were examined with magnetic resonance imaging（MRI）and ultrasonography before surgery.Final diagnosis was confirmed by surgery.The sensitivity,specificity and accuracy of MRI and US were analyzed.Results Among the 109 patients with biliary calculi,24 patients had cholecystolithiasis,32 patients had common duct stones,7 patients had calculi US of in-trahepatic duct,and there existed two or more sites of stones in 46 patients.The sensitivity,specificity and accuracy of MRI and US in detec-ting cholecystolithiasis were 87.63%,99.17%,92.98%,and 94.01%,95.09%,94.73%,respectively;the sensitivity,specificity and accu-racy of MRI and US in detecting common duct stones were 92.67%,97.33%,94.52%,and 76.44%,77.86%,76.71%,respectively;the sensitivity,specificity and accuracy of US and MRI in detecting calculi US of intrahepatic duct were 73.42%,84.82%,85.71%,and 75.31%,75.91%,75.00%,respectively.Conclusion US,used as a primary screening tool,can improve the diagnostic rate of cholecystoli-thiasis,which must be combined with MRI.In the imaging sequence of MRI and MRCP,the observation combined with T2WI,FIESTA-coronal and MRCP-original image is superior.