阻塞性黄疸ERCP后多层螺旋CT扫描观察

Evaluation of multi-slice CT scanning after ERCP in diagnosis of obstructive jaundice

目的 :评价ERCP后多层螺旋CT扫描 (简称ERCP后MSCT)与平扫、双期扫描对梗阻性黄疸病因的诊断价值。方法 :回顾性分析 76例经临床确诊为阻塞性黄疸的患者资料 ,其中ERCP后MSCT2 8例 ,平扫 13例 ,双期增强扫描 2 7例 ,平扫 +双期增强扫描 8例。检查方法 :采用螺旋模式扫描 ,重建层厚 2 .5～ 5mm ,ERCP后MSCT拔管后 1～ 2h进行。双期扫描注射造影剂为 80～ 10 0ml,速度为 2 .0～ 3.0ml/s,注药后 30s、80s扫描。观察指标包括 :①胆管扩张程度 ;②管壁清晰度 ;③扩张胆管全貌的显示。结果 :3种扫描技术总的管壁显示情况以ERCP后CT扫描最佳。ERCP后MSCT可进行多种三维重建 ,较好显示胆管内结节。结论 :ERCP后MSCT更适合显示沿人体纵向走行的细小胆管。建议采用 2 .5mm层厚显示胰胆管病变。

Aim:To evaluate the Multi slice CT (MSCT) scanning immediately after ERCP for the diagnosis of obstructive jaundice, and to compare the value between this method and dual phase scans and plane scans. Methods:Seventy six patients with obstructive jaundice were confirmed by surgical pathology or medicine therapy with follow up over 3 months. A total of 28 patients unsatisfactory results by ERCP had MSCT scan in 1～2 hours after ERCP, using the contrast material injected by ERCP, 27 cases were performed cases, plane scans, and 8 cases, both plane and enhanced scans were finished at the same period. Scan slices were 2.5～5 mm. Observing markers included: (a) degree of cholangiectasis; (b) border display of bile ducts; (c) three dimensional display (3D) of cholangiectasis.Results:3D images was easily obtained by MSCT after ERCP. Conclusion: MSCT after ERCP is superior to both dual phase and plane MSCT scan in demonstrating the anatomic details of the bile duct. The scanning slices and interval of 2.5 mm is suggested for biliary lesions.