摘要
目的良恶性胆道狭窄在诊疗手段的制订及预后等方面的差异较大,本文旨在探讨对磁共振胆胰管造影（MRCP）和CT动态增强扫描（DCE-CT）图像行量化分析,评估其诊断良恶性胆道狭窄的价值。资料与方法回顾性分析27例良性胆道狭窄（良性组）和30例恶性胆道狭窄（恶性组）患者的MRCP和DCE-CT资料,比较两组狭窄段胆管壁厚、长度、管径,狭窄段上方胆管扩张程度以及狭窄段管壁强化程度,并分析其与胆管狭窄性质的相关性,评估MRCP和DCE-CT预测胆道狭窄良恶性的诊断效能。结果恶性组狭窄段壁厚、长度及上方扩张段最末端胆管管径大于良性组[（3.2±2.0）mm对（2.1±0.6）mm、（15.8±8.1）mm对（9.5±6.5）mm、（12.7±3.6）mm对（9.3±2.7）mm]（t=2.825、3.270、4.025,P〈0.001）,狭窄段胆管管径明显小于良性组[0 mm对（2.0±0.9）mm]（Z=-3.909,P〈0.001）。胆管狭窄性质与狭窄段胆管壁厚、门静脉期-平扫和延迟期-平扫狭窄段管壁CT差值呈正相关,与狭窄段胆管管径呈负相关（t=-6.424-2.309,P〈0.05）。狭窄段壁厚、管径、门静脉期-平扫管壁CT差值及延迟期-平扫管壁CT差值是恶性胆道狭窄的重要预测因子（F=41.090,P〈0.001）。MRCP和DCE-CT诊断57例胆道狭窄患者的灵敏度、特异度、符合率及约登指数分别为96.67%、100.00%、98.25%、0.97,对胆道狭窄良恶性的预测差异有统计学意义（AUC=0.994,P〈0.001）。结论采用MRCP结合DCE-CT对良、恶性胆道狭窄进行量化分析,能更准确地诊断良恶性胆道狭窄,狭窄段胆管壁厚、管径、门静脉期-平扫管壁CT差值及延迟期-平扫管壁CT差值具有鉴别诊断价值。
Purpose The diagnosis, treatment and prognosis of benign and malignant biliary stricture are significantly different. This study aims to evaluate the quantitative analysis of biliary structures using magnetic resonance cholangiopancreatography （MRCP） combined with dynamic contrast enhanced CT （DCE-CT）.Materials and Methods The quantitative parameters of MRCP and DCE-CT imaging data from 27 patients with benign biliary stricture （benign group） and 30 patients with malignant biliary stricture （malignant group） were retrospectively analyzed. The wall thickness, stricture length and diameter, proximal ductal dilatation and degree of enhancement in two groups were compared, and its correlation was analyzed to evaluate the accuracy of MRCP and DCE-CT.Results There were significant differences in wall thickness [（3.2±2.0） mmvs （2.1±0.6） mm], stricture length [（15.8±8.1） mmvs （9.5±6.5） mm] and diameter [0 mmvs （2.0±0.9） mm], proximal ductal dilatation and the degree of enhancement [（12.7±3.6） mmvs （9.3±2.7） mm] between the two groups （t=2.825, 3.270, 4.025,P〈0.001;Z=-3.909,P〈0.001）. Multivariable stepwise regression analysis showed that the wall thickness and diameter, and the CT HU in portal venous and equilibrium phases combined with CT plain scanning were significant predictors of malignant biliary strictures （t=-6.424-2.309,P〈0.05）. The sensitivity, specificity, inter-modality agreement and Youden index of MRCP and DCE-CT in diagnosing 57 patients with biliary stricture were 96.67%, 100.00%, 98.25% and 0.97, respectively; with statistical significance in predicting benign and malignant biliary stricture （AUC=0.994,P〈0.001）.Conclusion Using MRCP and DCE-CT, the wall thickness and diameter of the stricture, and the difference in CT HU in portal venous and equilibrium phases combined with CT plain scanning are valuable in differential diagnosis of benign and malignant biliary stricture.
出处
《中国医学影像学杂志》
CSCD
北大核心
2015年第8期597-601,613,共6页
Chinese Journal of Medical Imaging
基金
安徽省自然科学基金项目(1208085MH179)
关键词
胆道疾病
缩窄
病理性
胰胆管造影术
磁共振
体层摄影术
X线计算机
图像增强
诊断
鉴别
Biliary tract diseases
Constriction
pathologic
Cholangiopancreatography
magnetic resonance
Tomography
X-ray computed
Image enhancement
Diagnosis
differential
