宝石能谱CT对胆囊炎伴早期微小穿孔的诊断价值

Value of gemstone spectral CT in the diagnosis of cholecystitis with early micro-perforation

目的分析宝石能谱CT对胆囊炎伴早期微小穿孔的诊断价值。方法收集我院收治的36例胆囊炎伴早期微小穿孔患者的临床资料,所有患者入院后均完成宝石能谱CT检查,先平扫,后作单能量成像,分析宝石能谱CT对胆囊炎伴早期微小穿孔的诊断价值。结果 (1)36例患者均经手术证实为胆囊炎伴微小穿孔,其中33例胆囊穿孔,3例胆总管穿孔,穿孔直径1~5 mm,平均(3.1±0.6)mm。(2)在40 ke V、140 ke V条件下,胆囊窝部与胆汁CT值差异较大,在60~80 ke V时差别较小,随ke V值上升,胆汁CT值减少,并接近负值,灰度变暗,而胆囊窝部CT值逐渐增加,且灰度增加;(3)胆囊炎伴微小穿孔患者脂/水图显示最为清晰,其胆囊窝部平均脂/水浓度、碘/水浓度均高于胆汁(P<0.05),且胆囊窝部K值高于胆汁(P<0.05)。结论宝石能谱CT单能量成像及脂/水基物质图成像可清晰显示胆囊炎伴早期微小穿孔,可将其作为胆囊炎伴微小穿孔临床诊断的有效手段。

Objective To analyze the value of gemstone spectral CT in the diagnosis of cholecystitis with early micro-perforation. Methods The clinical data of 36 cases with cholecystitis complicated with early micro-perforation in our hospital were collected. All patients completed gemstone spectral CT examination after admission. Firstly, plain scan was performed, and then the single energy imaging was performed. The value of gemstone spectral CT in the di- agnosis of cholecystitis with early micro-perforation was analyzed. Results All of the 36 patients with cholecystitis complicated with micro-perforation were confirmed by surgery, including 33 cases with gallbladder perforation, 3 cases with common bile duct perforation, and the diameter of perforation was 1-5mm, with an average of （3.1＋0.6） ram. Un- der 40keV and 140keV, the CT values of the fossa of gallbladder and bile were significantly different while under 60- 80keV, the differences were small. With the increase of keV value, CT values of bile decreased, close to the negative value, and the gray level was darkened. When the CT value of the fossa of gallbladder increased, the gray level in- creased. The lipid / water map of patients with cholecystitis and micro-perforation was the clearest, and the average lipid / water concentration and iodine / water concentration of fossa of gallbladder were higher than those of bile （P〈 0.05）, and the K value of gallbladder was higher than that of bile （P〈0.05）. Conclusion The lipid / water map of gemstone spectral CT single energy imaging can clearly show cholecystitis with early micro-perforation, which can be used as an effective means for clinical diagnosis of cholecystitis with micro-perforation.