螺旋CT在胆道系统的应用价值

近年来，螺旋CT和快速高场强MR的应用明显提高了良恶性胆管梗阻鉴别的能力，提高了胆道系统肿瘤诊断的准确性，也使得胆道系统早期肿瘤的检出成为可能。现在，一些新的检查技术如CT胆管造影(CT cholangiography，CTC)和磁共振胆道成像(MR cholangiagraphy MRC)逐渐成熟，成为研究的热点以及PTC和RCP强有力的挑战手段。

IDUS、CT和MRCP对胆道恶性梗阻的诊断价值

目的探讨腔内超声(IDUS)、CT和磁共振胰胆管造影(MRCP)和对胆道恶性梗阻的诊断价值。方法回顾性分析53例胆道恶性梗阻患者的IDUS、CT和MRCP检查结果,比较3种影像学检查方法对胆道恶性梗阻的图像特征和诊断情况。结果 IDUS、CT和MRCP对胆道恶性梗阻定位诊断准确率分别为65.31%、82.98%和82.93%,差异有统计学意义(P<0.05);而定性诊断准确率分别为63.27%、74.47%和75.61%,差异无统计学意义(P>0.05)。3种影像学检查方法均能显示胆道恶性梗阻的部位、数量和回声/密度/信号特征:CT和MRCP对壶腹癌定位诊断、胰头癌定性诊断均有较高符合率。IDUS对胆管狭窄性质的阴性预测能力明显高于CT和MRCP(P<0.05)。结论 IDUS、CT和MRCP均能清晰显示胆道恶性梗阻的特征,各有优势,具有较高的应用价值。

Clinical significance of magnetic resonance cholangiopancreatography utilizing half-Fourier acquisition single-shot fast spin-echo in diagnosing bile duct diseases

Objective: To investigate the clinical significance of magnetic resonance cholangiopancreatography (MRCP) utilizing half-Fourier acquisition single-shot fast spin-echo (HASTE) in the diagnosis of bile duct diseases. Methods: Forty-three patients with obstructive jaundice and 4 without were enrolled in this study. The underlying diseases included bile duct calculi ( 13 cases) , chronic cholangitis ( 14 cases) malignant tumors (18 cases) and congenital biliary cysts (2 cases). All patients underwent examinations with magnetic resonance imaging (MRI) and MRCP, and 39 were also examined with B-type ultrasonography, 33 with CT and 25 with ERCP and PTC. Three-dimensional image reconstruction was performed using volume-rendered technique ( VRE) on the basis of the data obtained by MRCP. Results: The biliary calculi were displayed as circular filling defects in MRCP images, with the proximal end of dilated bile duct taking the form of the mouth of a cup. The bile duct of patients with chronic cholangitis showed distal end dilation and thinner proximal end without discontinuity. Interception of the bile ducts was most frequent (72. 2% ) in cases of malignant bile duct obstruction, in which the ducts may also be mastoid or resembling rat tails. 72. 2% of the cases had severe dilation of the bile ducts, which occur in only 16. 0% of the benign cases, with significant difference between them (P <0. 01) . In images of intrahepatic biliary cyst, intrahepatic duct dilated in the shape of a bursa in connection with the duct. By MRCP, 20 malignant obstructions of the bile ducts were identified with 2 misdiagnoses, and in 25 cases of benign obstructions identified by MRCP, only 1 misdiagnoses occurred. Thus MRCP had the sensitivity, specificity and accuracy of 90.0% , 96.3% and 93.6% respectively in discriminating benign and malignant diseases of the bile ducts, showing a total diagnostic accuracy of 94. 0% that was similar to that of ERCP (92.0% ) but significantly higher than those of both CT (75. 0% ) and B-type ultrasonic examination (74. 0% ). Conclusion: In diagnosing obstructive jaundice, HASTE MRCP is similar to ERCP but better than CT and B-type ultrasonography , with the merits of fast imaging and high resolution as an ideal sequence for MRCP imaging.

45例先天性胆管扩张症影像学诊断分析

目的探讨45例先天性胆管扩张症患者的各种影像学诊断方法的优劣。方法对目前临床正在使用的3种主要的先天性胆管扩张症的影像学诊断方法进行总结及回顾性分析。结果先天性胆管扩张症的诊断受影像学检查方法不同而可能有不同的检查结果。结论对先天性胆管扩张症的影像学检查应首选US,US和MRCP联合检查能对该病有更全面的认识。