多层面螺旋CT胆道成像技术的临床应用

Clinical Application of Multi-slice Helical CT Cholangiography

目的 探讨多层面螺旋CT胆道成像技术 (MSCTC)要点及其临床应用价值。材料与方法 19例怀疑胆道梗阻患者 ,从周围静脉滴注 10 %胆影葡胺 10 0ml后 ,60～ 90分钟行上腹部快速容积扫描 ,利用图形工作站的后处理功能行胆道系统的三维重建 ,并将观察结果与原始横断面图像和临床病理进行对照。结果 ( 1) 15例血清胆红素低于 2mg/dl( 3 4 μmol/L)的病例中 14例胆道强化效果良好 ,而 4例血清胆红素高于 2mg/dl的病例中 3例强化效果较差。( 2 )与横断面图像相比 ,三维图像显示胆道梗阻的部位与病因更直观、准确 ,无假阳性和假阴性发生。( 3 )Raysum技术能去除强化胆汁的掩盖 ,更清楚地显示胆道系统的细小病变。结论 MSCTC是一种安全可靠、简便易行的胆道系统无创伤检查技术 ,尤其对血清胆红素低于 2mg/dl的病例有很高的临床应用价值。

Objective To probe the key points of multi slice helical CT cholangiography (MSCTC) technique, and to assess its clinical application.Materials and Methods 60～90 minutes after intravenous infusion of 100ml of 10% iodipamide meglumine, thin slice volumetric CT scanning of upper abdomen was performed in 19 patients with clinically suspected biliary disease. 3D reconstruction of the raw data was done, and the images thus obtained were compared with the original axial pictures and the pathologic findings. Results (1) MSCTC well displayed the biliary tree in 14 of 15 patients with serum bilirubin level lower than 2mg/dL, and also in 3 of 4 patients with serum bilirubin level greater than 2mg/dL. (2) Compared with the original axial images, 3D images revealed the biliary obstruction site and lesion more directly and more clearly, without any false positive and false negative. (3) 3D Raysum images could eliminate the enhanced bile and discover small lesions more clearly. Conclusion MSCTC is a safe, reliable, simple and noninvasive technique for the visualization of the biliary tree, especially useful for patients whose serum bilirubin levels are less than 2mg/dL.