磁共振胰胆管成像联合腹部CT检查在肝外胆管结石诊断中的效能

Efficacy of magnetic resonance cholangiopancreatography combined with abdominal CT in diagnosis of extrahepatic bile duct stones

目的:观察磁共振胰胆管成像(MRCP)联合腹部CT检查在肝外胆管结石诊断中的效能。方法:选取128例疑似肝外胆管结石患者为研究对象,均行经内镜逆行性胰胆管造影术、腹部CT检查和MRCP检查。以内镜逆行性胰胆管造影术检查结果为“金标准”,比较MRCP检查、腹部CT检查、MRCP联合腹部CT检查诊断肝外胆管结石的效能(灵敏度、准确度、特异度、漏诊率和误诊率)和不同大小结石检出率。结果:128例疑似肝外胆管结石患者中,经内镜逆行性胰胆管造影术检查诊断为肝外胆管结石阳性111例,阴性17例;经内镜逆行性胰胆管造影术检查结果显示,111例肝外胆管结石患者中共存在261块结石,其中直径>9 mm结石118块,直径≤9 mm结石143块;MRCP联合腹部CT检查诊断肝外胆管结石的灵敏度、准确度均高于MRCP、腹部CT单项检查,MRCP联合腹部CT检查诊断肝外胆管结石的漏诊率低于MRCP、腹部CT单项检查,差异有统计学意义(P<0.05);MRCP联合腹部CT检查对直径>9 mm结石、直径≤9 mm结石的检出率均高于MRCP、腹部CT单项检查,差异有统计学意义(P<0.05);MRCP联合腹部CT检查诊断肝外胆管结石的特异度、误诊率与MRCP、腹部CT单项检查比较,差异无统计学意义(P>0.05)。结论:MRCP联合腹部CT检查在肝外胆管结石诊断中的效能和结石检出率高于MRCP、腹部CT单项检查。

Objective:To observe efficacy of magnetic resonance cholangiopancreatography(MRCP)combined with abdominal CT in diagnosis of extrahepatic bile duct stones.Methods:128 patients with suspected extrahepatic bile duct stones were selected as the research objects,and all underwent endoscopic retrograde cholangiopancreatography,abdominal CT examination and MRCP examination.Using the results of endoscopic retrograde cholangiopancreatography as the“gold standard”,the efficacies of MRCP,abdominal CT,and MRCP combined with abdominal CT in the diagnosis of extrahepatic bile duct stones(sensitivity,accuracy,specificity,missed diagnosis rate,and misdiagnosis rate)and the detection rate of stones of different sizes were compared.Results:Among the 128 patients with suspected extrahepatic bile duct stones,111 cases were diagnosed as positive extrahepatic bile duct stones by endoscopic retrograde cholangiopancreatography,and 17 cases were negative.The endoscopic retrograde cholangiopancreatography also showed that a total of 261 stones were found in these patients,of which 118 stones were larger than 9 mm in diameter and 143 stones were≤9 mm in diameter.The sensitivity and the accuracy of MRCP combined with abdominal CT in the diagnosis of extrahepatic bile duct stones were higher than those of single MRCP and single abdominal CT;the missed diagnosis rate was lower than that of single MRCP and single abdominal CT;and the differences were statistically significant(P<0.05).The detection rates of MRCP combined with abdominal CT examination for stones larger than 9 mm and diameter≤9 mm were higher than those of single MRCP and single abdominal CT,and the differences were statistically significant(P<0.05).However,there were no statistical differences in the specificity and the misdiagnosis rate among MRCP combined with abdominal CT and single MRCP and single abdominal CT(P>0.05).Conclusions:The efficacy and the stone detection rate of MRCP combined with abdominal CT in the diagnosis of extrahepatic bile duct stones are higher than single MRCP and single abdominal CT.