经腹超声、腹部CT和MRCP在胆总管结石诊断中的比较分析

Comparative Analysis of Transabdominal Ultrasonography, Abdominal CT and MRCP in Diagnosis of Choledocholith

目的 探讨经腹超声、腹部CT和磁共振胰胆管成像(MRCP)3种检查方法对胆总管结石诊断的效能。方法 回顾性分析2020年1月至2020年12月在我院消化科住院的84例可疑胆总管结石患者的临床资料,包括年龄、性别、经腹超声、腹部CT和MRCP检查结果等。比较3种方法对胆总管结石的诊断灵敏度、特异度、阳性预测值、阴性预测值、准确率及对胆总管扩张的检出率。结果 84例可疑胆总管结石患者中,通过内镜下逆行胰胆管造影(ERCP)检查(金标准)及相关治疗明确诊断为胆总管结石的患者76例,经腹超声检查、腹部CT检查及磁共振胰胆管成像(MRCP)检查的灵敏度分别为(55.26%、77.63%、93.42%),准确率分别为(57.14%、76.19%、92.85%)。3种检查方法对胆总管结石(CBDS)的诊断灵敏度、准确率不同,差异有统计学意义(P <0.05);3种检查方法的诊断特异度(75.00%、62.50%、87.50%)、阳性预测值(95.45%、95.16%、98.61%)、阴性预测值(15.00%、22.72%、58.33%)和对胆管扩张的检出率(61.90%、71.43%、73.81%)之间无明显差异(P> 0.05)。结论 3种检查方法对胆总管结石的诊断能力结果显示MRCP>腹部CT>经腹超声。

Objective To investigate the diagnostic efficacy of transabdominal ultrasonography,abdominal CT and magnetic resonance cholangiopancreatography(MRCP) in choledocholith. Methods The clinical data of 84 patients with suspected choledocholith hospitalized in our hospital from January 2020 to December 2020 were retrospectively analyzed, including age, sex, results of transabdominal ultrasonography, abdominal CT and MRCP. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and detection rate of common bile duct dilatation were compared among the three methods. Results Among 84 patients with suspected choledocholithiasis,76 patients were definitely diagnosed with choledocholith through ERCP examination(gold standard) and related treatment. The sensitivity of transabdominal ultrasonography, abdominal CT and MRCP were 55.26%, 77.63%, 93.42%, and the accuracy of three methods were 57.14%, 76.19%, 92.85%, respectively. The sensitivity accuracy of the three examination methods in the diagnosis of CBDS was different, and the difference was statistically significant(P<0.05). The specificity of diagnosis(75.00%, 62.50%, 87.50%), positive predictive value(95.45%, 95.16%, 98.61%), negative predictive value(15.00%, 22.72%, 58.33%) and the detection rate of bile duct dilatation(61.90%, 71.43%, 73.81%) of the three examination methods were different, but there was no significant difference(P>0.05).Conclusion The diagnostic ability of the three examination methods for choledocholith showed that MRCP>abdominal CT>transabdominal ultrasound.