本文選題：膽道梗阻 + 容積CT��； 參考：《山西醫(yī)科大學(xué)》2013年碩士論文

【摘要】：【目的】通過分析良、惡性膽道梗阻性疾病的影像學(xué)特點(diǎn),探討陰性法膽道成像(negat i ve CT chol angi ogr aphy N-CTC)技術(shù)對(duì)膽道梗阻定位、定性的診斷價(jià)值,為N-CTC的臨床應(yīng)用提供較為可靠的理論依據(jù)。 【材料與方法】收集我院2008年7月至2012年12月經(jīng)臨床手術(shù)病理證實(shí)或經(jīng)ERCP活檢取得病理的膽道梗阻患者47例,男29例,女18例,年齡12～87歲,平均59.6歲。所有患者均以黃疸或疼痛就診,其中34例為無痛性黃疸,11例腹部疼痛伴黃疸,2例疼痛但不伴黃疸。發(fā)現(xiàn)黃疸時(shí)間1天～2周,具體情況見表1。所有患者于檢查前均需進(jìn)行胃腸道準(zhǔn)備,其中30例通過飲水充盈消化道,17例口服陽(yáng)性對(duì)比劑充盈消化道,要求在10～20分鐘內(nèi)飲1000ml,同時(shí)肌注6.542注射液10毫克,10分鐘后再行64排螺旋CT平掃及增強(qiáng)掃描,并將所有原始圖像傳入Vi t ea2.0工作站進(jìn)行三維重組,利用門靜脈期圖像獲得N-CTC圖像,根據(jù)需要進(jìn)行冠狀位、矢狀位及斜位等多平面重組(multi-planar r ef or rrat i on, IVPR)和曲面重組(curved-planar ref or rrat i on, CPR)圖像,所有重組圖像重組層厚為1m，，重組間隔為0.5mm, 47例患者中有25例行磁共振胰膽管成像(IVR-chol angi opancr eat ogr aphy, IVRCP)掃描,然后由兩位高年資診斷醫(yī)師根據(jù)原始軸位圖像、三維重組的N-CTC圖像及IVRCP圖像進(jìn)行梗阻的定位和定性診斷,并與術(shù)后病理及ERCP診斷進(jìn)行比較。計(jì)算N-CTC、MRCP對(duì)膽道梗阻性疾病的診斷準(zhǔn)確性的靈敏度、特異度及約登指數(shù)。 【結(jié)果】64排螺旋CT N-CTC可以清晰顯示良、惡性梗阻性疾病的特征性表現(xiàn)。47例膽道梗阻患者中：64排螺旋CT N-CTC及MRCP對(duì)良、惡性梗阻的定位診斷準(zhǔn)確率均為100%N-CTC對(duì)良、惡性梗阻的定性診斷靈敏度和特異度分別為82.4%(14/17)和86.7%/(26/30),約登指數(shù)為0.691；而MRCP對(duì)良、惡性梗阻的定性診斷靈敏度和特異度分別為83.3%(5/6)和94.7%(18/19),約登指數(shù)為0.78。 【結(jié)論】64排螺旋CT陰性法膽道成像是一種便捷、無創(chuàng)傷性檢查方法,臨床應(yīng)用方便、可行,與橫斷面圖像結(jié)合可顯示膽管周圍的解剖結(jié)構(gòu)和毗鄰關(guān)系,清晰地顯示出膽道梗阻性疾病良惡性的CT特征,直觀顯示膽管病變,對(duì)膽道梗阻的定位和定性診斷均具有重要價(jià)值。
[Abstract]:[objective] to analyze the imaging features of benign and malignant biliary obstructive diseases and to explore the diagnostic value of negat i ve CT chol angi ogr aphy N-CTCCtechnique in the diagnosis of biliary obstruction. To provide a more reliable theoretical basis for the clinical application of N-CTC. [materials and methods] from July 2008 to December 2012, 47 patients with biliary obstruction, 29 males and 18 females, aged 1287 years (mean 59.6 years), were pathologically confirmed or pathologically obtained by ERCP biopsy in our hospital. All the patients were treated with jaundice or pain, of which 34 were painless jaundice, 11 patients with abdominal pain and jaundice, 2 patients with pain but not with jaundice. Jaundice was found in 1 day and 2 weeks, as shown in Table 1. All patients were required to prepare their gastrointestinal tract before examination, of which 30 cases were filled with digestive tract through drinking water and 17 cases were filled with oral positive contrast agent. We were asked to drink 1000ml within 10 ~ 20 minutes and 6.542 injection 10 mg / min. After 10 minutes, 64-slice spiral CT plain scan and enhanced scan were performed, and all the original images were transferred to Vi t ea2.0 workstation for 3D recombination. The N-CTC images were obtained by portal vein phase images. Coronal, sagittal and oblique multi-planar r ef or rrat i on, IVPR) and curved-planar ref or rrat i on, CPR) images were performed. Of the 47 patients, 25 underwent Mr cholangiopancreatography (Mr cholangiopancreatography) IVR-chol angi opancr eat ogr aphy, IVRCP) scan, and then two senior Diagnostics performed the localization and qualitative diagnosis of obstruction according to the original axial images, three-dimensional reconstructed N-CTC images and IVRCP images. And compared with postoperative pathology and ERCP diagnosis. The sensitivity, specificity and Jordan index of N-CTCMr MRCP in the diagnosis of biliary obstructive diseases were calculated. [results] 64-slice spiral CT N-CTC could clearly show the characteristic manifestations of benign and malignant obstructive diseases. In 47 patients with biliary obstruction, the accuracy of diagnosis of benign and malignant obstruction by N-CTC and MRCP was both 100%N-CTC versus benign. The sensitivity and specificity of qualitative diagnosis of malignant obstruction were 82.414 / 17) and 86.7 / 26 / 30, respectively, and the Jorden index was 0.691, while the sensitivity and specificity of MRCP in qualitative diagnosis of benign and malignant obstruction were 83.3 / 6 and 94.7 / 18 / 19, respectively, and the Jorden index was 0.78. [conclusion] 64-slice spiral CT negative cholangiography is a convenient, non-traumatic examination method. It is convenient and feasible in clinical application. Combined with cross-sectional images, the anatomical structure and adjacent relationship around the bile duct can be displayed. Clearly showing the CT features of benign and malignant biliary obstructive diseases and visualizing bile duct lesions are of great value for the location and qualitative diagnosis of biliary obstruction.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R816.5

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