多排螺旋CT三维成像技术在胆系的临床应用

Multi-slice helical CT 3D cholangiography and its clinical application

目的 探讨多排螺旋CT三维成像技术对胆系疾病的诊断价值。方法 146例胆系疾病患者 ,其中胆系肿瘤 73例 ,胆系阴性结石 87例 ,胆肠吻合术后 12例 ,先天性胆总管囊肿 1例。CT容积扫描所获图像数据送工作站处理 ,选择合理的成像方法 ,胆系成像方法包括最大密度投影法(MIP)、最小密度投影法 (MinP)、仿真内窥镜 (CTVE)、表面遮盖法 (SSD)和Raysum。对比分析胆系成像、常规CT、US及ERCP对各疾病的诊断准确率。结果 各疾病在胆系成像上均有较特征性的表现 ;胆系成像是一种评价胆肠吻合术的新手段 ;对胆系结石、胆总管癌、胆管癌栓、胰头癌、壶腹周围癌的诊断 ,胆系成像优于常规CT、US、ERCP ;对于肝门部胆管癌的诊断 ,胆系成像优于常规CT、US ,与ERCP相当 ;对胆囊癌的诊断 ,不如常规CT、US。结论 胆系成像是一种诊断胆系疾病的无创、敏感的新方法 ,确诊率高 ,将极大地提高胆系疾病的术前诊断水平。

Objective To assess the technique of multi-slice helical CT 3D cholangiography (3D-CTC) and it clinical application in the diagnosis of biliary tract diseases. Methods Thin-slice volumetric CT scanning was performed in 146 patients including 73 of biliary tract tumor, 87 of negative calculus, 12 of post-cholangio-jejunostomy and 1 of congenital cyst of common bile duct. All images with thin collimation and overlapping reconstruction were transferred to workstation (GE Advantage windows 3.1). Rational 3D-CTC including Maximum Intensity Projection (MIP), Minimum Intensity Projection (MinP), Surface Shaded Display (SSD), CT virtual endoscopy (CTVE) and Ray Sumption was performed. The rates of correct diagnosis by routine CT, US and ERCP were comparatively analyzed. Results 1) Different diseases had different imaging features in 3D-CTC. 2) 3D-CTC was an advanced technique for evaluation of post-cholangio-jejunostomy. 3) 3D-CTC was better than routine CT, US and ERCP in diagnosis of negative calculus, extrahepatic cholangiocarcinoma, cancer thrombus of bile duct, carcinoma of the head of pancreas and peri-ampullar carcinoma. 4) In the diagnoses of hilar cholangiocarcinoma and gallbladder carcinoma, 3D-CTC was worse than routine CT, US and ERCP. Conclusions 3D-CTC is a safe and sensitive technique. Therefore, it can well show biliary anatomy and greatly improve the rate of correct diagnosis of biliary diseases.