飲水低張多層螺旋CT膽道成像的臨床研究
發(fā)布時(shí)間：2018-07-26 15:44
【摘要】：背景膽道梗阻性疾病，是臨床常見(jiàn)的疾病之一，其臨床癥狀以黃疸、腹痛為主，患者多起病急，癥狀較嚴(yán)重。對(duì)于膽道梗阻性疾病，可選擇的影像學(xué)檢查方法多樣。臨床常用有創(chuàng)的檢查方法為：經(jīng)皮經(jīng)肝穿刺膽道造影（PTC）以及經(jīng)內(nèi)窺鏡逆行性胰膽管造影（ERCP）、靜脈膽道造影（IVC）,無(wú)創(chuàng)的檢查方法為：X線(xiàn)口服膽囊造影、B超、CT膽道成像（CTC）以及磁共振胰膽成像（MRCP）等。以上檢查方法，各有利弊，臨床可根據(jù)具體情況，加以選擇或靈活組合運(yùn)用。目前，此方面疾病的診斷，越來(lái)越依靠無(wú)創(chuàng)性影像學(xué)檢查，而MSCT，因其價(jià)格便宜、檢查方便、信息量大、適應(yīng)癥寬，成為臨床醫(yī)生在膽道疾病檢查的重要手段。MSCT在膽道成像方面的檢查，分為螺旋CT膽道成像（Spiral CT Cholangiography，SCTC）及陰性法螺旋CT膽道成像（negative MSCT Cholangiography N-CTC），陽(yáng)性法膽道成像需要靜脈注射或者口服膽系造影劑，在造影劑充盈膽系時(shí)進(jìn)行掃描，利用含陽(yáng)性造影劑的高密度膽系與周?chē)兔芏雀闻K組織的密度差異，可以獲得膽系的三維成像，但SCTC受血清膽紅素影響較大，加上檢查準(zhǔn)備時(shí)間長(zhǎng)，目前應(yīng)用較少。陰性法CT膽道成像，是近年來(lái)快速發(fā)展起來(lái)的一種無(wú)創(chuàng)性膽道成像技術(shù)，原理為通過(guò)靜脈注射非離子型碘對(duì)比劑，對(duì)胰腺、肝臟、膽管壁等實(shí)質(zhì)臟器強(qiáng)化而膽道系統(tǒng)不排泄造影劑，從而使膽道系統(tǒng)呈現(xiàn)相對(duì)低密度而成像。目前此法對(duì)膽道梗阻性疾病的診斷價(jià)值日益得到認(rèn)可。本研究中運(yùn)用飲水低張下MSCT膽道成像方法，是以N-CTC為基礎(chǔ)，在準(zhǔn)備工作中要求患者分時(shí)段大量飲水，充盈十二指腸圈，掃描前15分鐘臀部肌肉注射鹽酸消旋山莨菪堿注射液（654-2），對(duì)十二指腸圈及壺腹部括約肌松弛，充分顯示擴(kuò)張的膽道系統(tǒng)，提供盡可能多的診斷信息，以達(dá)到方便診斷的目的。 CT檢查對(duì)膽道梗阻性疾病的診斷意義重大，在定性、定位、術(shù)前分期、手術(shù)選擇方式等方面有重要作用。如何合理、有效的利用CT檢查，是臨床及影像學(xué)醫(yī)生的必要任務(wù)。目前我們使用的64排（128層）螺旋CT，掃描時(shí)間快，單位時(shí)間覆蓋率高，可以一次屏氣像完成胸腹部掃描，，采集信息多，圖像偽影少，掃描及重建層厚變薄，層厚可達(dá)到0.625mm，同時(shí)擁有強(qiáng)大的三維后處理技術(shù)，可以達(dá)到各向同性要求，目前后處理工作站上提供多平面重建（multi planner-reconstruction，MPR）、曲面重建（curved planar reformation，CPR）、容積重建（volume rendering，VR）以及最小密度投影（minimum intensity projection，MinIP）等重建技術(shù)，這些技術(shù)的應(yīng)用，改變傳統(tǒng)的CT以軸位觀察為主的模式，提供了立體的、多角度觀察病變的方式，對(duì)膽道疾病的早期診斷、鑒別診斷以及定位、定性診斷大有幫助。本研究第一部分收集病例對(duì)飲水低張下MSCT與非飲水低張MSCT在膽道梗阻性疾病的定位、定性方面進(jìn)行對(duì)照性研究；第二部分對(duì)MPR、CPR、MinIP三種三維重建方法在膽道梗阻性疾病的應(yīng)用進(jìn)行比較分析，探討其應(yīng)用價(jià)值；第三部分對(duì)良、惡性膽道病變?cè)陲嬎蛷埾翸SCT的影像學(xué)特征進(jìn)行分析，在膽道梗阻疾病的CT診斷與鑒別診斷方面進(jìn)行研究。第四部分對(duì)既行飲水低張MSCT檢查，又做磁共振MRCP的患者資料進(jìn)行分析，對(duì)MSCT及MRCP對(duì)膽道梗阻患者定位、定性準(zhǔn)確率進(jìn)行比較。 研究一飲水低張MSCT膽道成像技術(shù)對(duì)膽道梗阻性疾病診斷的影響目的：探討飲水低張MSCT技術(shù)在膽道梗阻性疾病成像的診斷價(jià)值。方法收集140例因梗阻性黃疸行MSCT膽道成像檢查的患者，隨機(jī)分為低張組與常規(guī)組兩組，低張組70例行飲水低張下MSCT膽道成像；常規(guī)組70例常規(guī)MSCT膽道成像。兩組影像學(xué)診斷結(jié)果與病理或ERCP結(jié)果對(duì)比，比較兩組間在定位、定性診斷中的差異。結(jié)果低張組在膽道第3段定位準(zhǔn)確性高于常規(guī)組（χ2=4.09,P0.05），低張組在惡性病變定性準(zhǔn)確率高于常規(guī)組（χ2=6.73，P0.01）。結(jié)論飲水低張MSCT技術(shù)在低位、惡性膽道梗阻性疾病的診斷中，具有一定優(yōu)勢(shì)。 研究二三維重建技術(shù)在飲水低張MSCT膽道成像中的應(yīng)用目的比較多種三維重建技術(shù)在膽道梗阻性疾病中的應(yīng)用價(jià)值，探討其應(yīng)用價(jià)值方法三維重建方法為多平面重建法（MPR）、曲面重建法（CPR）、最小密度投影法（MinIP），對(duì)三種三維重建技術(shù)在膽道梗阻的應(yīng)用價(jià)值進(jìn)行分析。結(jié)果三種圖像質(zhì)量間秩和檢驗(yàn)結(jié)果無(wú)明顯差異。在滿(mǎn)足診斷要求評(píng)分中三者秩和檢驗(yàn)結(jié)果有統(tǒng)計(jì)學(xué)差異。三種重建方法單獨(dú)診斷定性、定位診斷正確率最高的為MPR。結(jié)論三種三維重建方法中對(duì)膽道梗阻性疾病有較高應(yīng)用價(jià)值的是MPR,合理選擇和利用三維重建技術(shù)，是軸位圖像的良好補(bǔ)充，能提供更多的診斷價(jià)值。 研究三良、惡性膽道梗阻疾病飲水低張MSCT表現(xiàn)分析目的分析膽道良、惡性疾病的表現(xiàn)在飲水低張MSCT，探索飲水低張MSCT在膽道疾病的診斷中的價(jià)值。方法對(duì)70例患者膽系擴(kuò)張形態(tài)、程度以及梗阻端部位、形態(tài)進(jìn)行統(tǒng)計(jì)分析結(jié)果肝內(nèi)膽管擴(kuò)張程度在兩組間不具有統(tǒng)計(jì)學(xué)意義（p㧐0.05）；膽總管擴(kuò)張程度在兩組間具有統(tǒng)計(jì)學(xué)意義（P0.05），肝內(nèi)膽管擴(kuò)張形態(tài)兩組間有統(tǒng)計(jì)學(xué)意義（P0.05）。梗阻端形態(tài)兩組間有統(tǒng)計(jì)學(xué)意義（P0.05）。在梗阻部位兩組間有統(tǒng)計(jì)學(xué)意義（P0.05），提示低位梗阻提示惡性可能。動(dòng)態(tài)增強(qiáng)中，惡性腫瘤則因病理種類(lèi)不同而表現(xiàn)各異。結(jié)論認(rèn)真比較分析良、惡性膽道梗阻疾病的影像學(xué)特征，能提高M(jìn)SCT診斷的準(zhǔn)確率。 研究四飲水低張MSCT膽道成像與MRCP的對(duì)照研究目的對(duì)比飲水低張MSCT及MRCP在膽道梗阻性疾病診斷中的意義。方法對(duì)30例膽道梗阻性疾病患者的飲水低張MSCT及MRCP下的定位、定性準(zhǔn)確率進(jìn)行對(duì)照分析。結(jié)果兩種檢查方法的定性、定位準(zhǔn)確率接近，無(wú)顯著性差異。結(jié)論飲水低張MSCT是MRCP的良好替代和互補(bǔ)的檢查方法。
[Abstract]:Obstructive disease of the biliary tract is one of the common clinical diseases. The clinical symptoms are jaundice and abdominal pain. The patients have more acute and severe symptoms. There are a variety of selective imaging methods for biliary obstructive diseases. The commonly used invasive methods are percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde. Sexual cholangiopancreatography (ERCP), venous cholangiography (IVC), noninvasive examination methods: X-ray oral cholecystography, B-ultrasound, CT biliary tract imaging (CTC) and magnetic resonance cholangiopancreatography (MRCP). The above examination methods have advantages and disadvantages, and can be selected or flexibly combined according to specific conditions. At present, the diagnosis of this disease is becoming more and more dependent Non invasive imaging examination, and MSCT, because of its cheap price, convenient inspection, large amount of information and wide adaptation, it has become an important means of biliary tract disease examination by clinicians,.MSCT in biliary tract imaging (Spiral CT Cholangiography, SCTC) and negative spiral CT biliary tract imaging (negative MSCT Cholangiog). Raphy N-CTC), the positive method of biliary tract imaging requires intravenous or oral cholangiopaniography, scanning when the contrast agent fills the bile system. The three-dimensional imaging of the biliary system can be obtained by using the density difference between the high density biliary system containing the positive contrast medium and the surrounding low density liver tissue, but the SCTC is influenced greatly by the serum bilirubin, plus the examination preparation. The negative method of CT biliary tract imaging is a noninvasive biliary tract imaging technique which has been developed rapidly in recent years. The principle is to strengthen the pancreas, liver and bile duct wall by intravenous injection of non ionic iodine contrast agent and do not excretion contrast agent in the biliary tract system, so that the biliary system is relatively low density. Imaging. The diagnostic value of this method is increasingly recognized in the diagnosis of biliary obstructive diseases. In this study, the low tension MSCT method of drinking water in this study is based on N-CTC, which requires a large amount of drinking water, filling the duodenum, and intramuscular injection of Raceanisodamine Hydrochloride Injection (65) in the first 15 minutes of the preparatory work. 4-2) provide adequate diagnostic information for the relaxation of the duodenal and ampullary sphincter muscles, fully displaying the dilated biliary tract system, so as to facilitate the diagnosis.
CT examination is of great significance in diagnosis of biliary obstructive diseases. It plays an important role in qualitative, location, preoperative staging, and surgical selection. It is a necessary task for clinical and imaging doctors how to rationally and effectively use CT examination. At present, the 64 row (128 layer) spiral CT we use is fast scanning time and high coverage per unit time. One breath hold the chest and abdomen scan, with more information, less image artifact, thinner thickness of scanning and reconstruction layer, and the thickness of layer can reach 0.625mm. At the same time, it has a powerful 3D post-processing technology, which can meet the isotropic requirement. At present, the post processing workstation provides multi planner-reconstruction, MPR, surface reconstruction (curved PL). ANAR reformation, CPR), volume reconstruction (volume rendering, VR), and minimum density projection (minimum intensity projection, MinIP), such as minimum intensity projection, MinIP, are used to change the traditional mode of CT with axial observation, providing a stereoscopic, multi angle observation of the disease, early diagnosis and differential diagnosis of biliary diseases. The first part of this study collected cases on the location of MSCT and non drinking low tension MSCT in the obstructive diseases of the biliary tract, and made a comparative study on the qualitative aspects. The second part was to compare and analyze the application of the three three-dimensional reconstruction methods of MPR, CPR and MinIP in the biliary tract obstruction disease. The third part of the third part is the analysis of the imaging features of the benign and malignant biliary tract lesions under the low tension of drinking water, the CT diagnosis and differential diagnosis of the biliary obstruction disease. The fourth part is the analysis of the patients with the low tension MSCT of drinking water and the data of the MRI MRCP, and the determination of MSCT and MRCP to the patients with biliary obstruction. Position, qualitative accuracy rate is compared.
The purpose of this study was to investigate the effect of drinking water low MSCT biliary tract imaging on the diagnosis of biliary obstructive diseases: To explore the diagnostic value of low tension MSCT technique in the diagnosis of biliary obstructive diseases. Methods 140 patients with obstructive jaundice with MSCT biliary tract imaging were randomly divided into two groups of low tension group and routine group, and 70 cases in low tension group were drinking water. Low tension MSCT biliary tract imaging; routine group 70 cases of routine MSCT biliary tract imaging. The two groups of imaging diagnosis results were compared with pathological or ERCP results, and the differences between the two groups were compared in the location and qualitative diagnosis. Results the accuracy of the third segments in the biliary tract was higher than that of the conventional group (x 2=4.09, P0.05), and the qualitative accuracy rate of the low tension group was higher than that of the normal group. Regulation group (x 2=6.73, P0.01). Conclusion drinking water hypotonic MSCT technology has certain advantages in the diagnosis of low level and malignant biliary obstructive disease.
Objective to study the application of two three-dimensional reconstruction technique in the low tension MSCT cholangio imaging of drinking water. Comparison of the application value of multiple three-dimensional reconstruction techniques in biliary obstructive diseases, the application value method of three-dimensional reconstruction method is multi plane reconstruction (MPR), surface reconstruction (CPR), minimum density projection (MinIP), and three three dimensional reconstruction techniques The application value of biliary obstruction was analyzed. Results there was no significant difference between the rank and test results of the three kinds of image quality. There was a statistical difference between the rank and test results of the three methods in meeting the diagnostic requirements. Three kinds of reconstruction methods were separately diagnosed and qualitative, and the highest correct rate of location diagnosis was MPR. conclusion in three three-dimensional reconstruction methods for biliary obstruction. It is MPR that has a high value in sexual diseases. Rational selection and utilization of three-dimensional reconstruction technology is a good complement to axial images and can provide more diagnostic value.
Analysis of the low tension MSCT manifestations of three good and malignant biliary obstruction diseases objective analysis of good bile duct and malignant disease in drinking water low MSCT, to explore the value of low tension MSCT in the diagnosis of biliary tract diseases. Methods 70 cases of biliary dilatation, degree and the end of the obstruction, morphology were statistically analyzed and the results of intrahepatic bile duct expansion were analyzed. Zhang Chengdu did not have statistical significance between the two groups (P? 0.05); the extent of choledochal dilatation was statistically significant between the two groups (P0.05), and there were statistical significance between the two groups of intrahepatic bile duct dilatation (P0.05). There were statistical significance between the two groups of the obstructive end form (P0.05). The lower obstruction was statistically significant (P0.05), suggesting low level obstruction. It is possible to show malignancy. In dynamic enhancement, the malignant tumor is different because of the different pathological types. Conclusion a careful comparison and analysis of the imaging features of benign and malignant biliary obstruction can improve the accuracy of MSCT diagnosis.
Study four the comparative study of low tension MSCT cholangiography and MRCP in drinking water objective to compare the significance of drinking water low tension MSCT and MRCP in the diagnosis of biliary obstructive diseases. Methods the location of low MSCT and MRCP of drinking water in 30 cases of biliary obstruction and the qualitative accuracy rate were compared. Results two kinds of examination methods were qualitatively and accurately located. Conclusion hypotonic MSCT in drinking water is a good alternative and complementary examination method for MRCP.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類(lèi)號(hào)】：R816.5
本文編號(hào)：2146495
[Abstract]:Obstructive disease of the biliary tract is one of the common clinical diseases. The clinical symptoms are jaundice and abdominal pain. The patients have more acute and severe symptoms. There are a variety of selective imaging methods for biliary obstructive diseases. The commonly used invasive methods are percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde. Sexual cholangiopancreatography (ERCP), venous cholangiography (IVC), noninvasive examination methods: X-ray oral cholecystography, B-ultrasound, CT biliary tract imaging (CTC) and magnetic resonance cholangiopancreatography (MRCP). The above examination methods have advantages and disadvantages, and can be selected or flexibly combined according to specific conditions. At present, the diagnosis of this disease is becoming more and more dependent Non invasive imaging examination, and MSCT, because of its cheap price, convenient inspection, large amount of information and wide adaptation, it has become an important means of biliary tract disease examination by clinicians,.MSCT in biliary tract imaging (Spiral CT Cholangiography, SCTC) and negative spiral CT biliary tract imaging (negative MSCT Cholangiog). Raphy N-CTC), the positive method of biliary tract imaging requires intravenous or oral cholangiopaniography, scanning when the contrast agent fills the bile system. The three-dimensional imaging of the biliary system can be obtained by using the density difference between the high density biliary system containing the positive contrast medium and the surrounding low density liver tissue, but the SCTC is influenced greatly by the serum bilirubin, plus the examination preparation. The negative method of CT biliary tract imaging is a noninvasive biliary tract imaging technique which has been developed rapidly in recent years. The principle is to strengthen the pancreas, liver and bile duct wall by intravenous injection of non ionic iodine contrast agent and do not excretion contrast agent in the biliary tract system, so that the biliary system is relatively low density. Imaging. The diagnostic value of this method is increasingly recognized in the diagnosis of biliary obstructive diseases. In this study, the low tension MSCT method of drinking water in this study is based on N-CTC, which requires a large amount of drinking water, filling the duodenum, and intramuscular injection of Raceanisodamine Hydrochloride Injection (65) in the first 15 minutes of the preparatory work. 4-2) provide adequate diagnostic information for the relaxation of the duodenal and ampullary sphincter muscles, fully displaying the dilated biliary tract system, so as to facilitate the diagnosis.
CT examination is of great significance in diagnosis of biliary obstructive diseases. It plays an important role in qualitative, location, preoperative staging, and surgical selection. It is a necessary task for clinical and imaging doctors how to rationally and effectively use CT examination. At present, the 64 row (128 layer) spiral CT we use is fast scanning time and high coverage per unit time. One breath hold the chest and abdomen scan, with more information, less image artifact, thinner thickness of scanning and reconstruction layer, and the thickness of layer can reach 0.625mm. At the same time, it has a powerful 3D post-processing technology, which can meet the isotropic requirement. At present, the post processing workstation provides multi planner-reconstruction, MPR, surface reconstruction (curved PL). ANAR reformation, CPR), volume reconstruction (volume rendering, VR), and minimum density projection (minimum intensity projection, MinIP), such as minimum intensity projection, MinIP, are used to change the traditional mode of CT with axial observation, providing a stereoscopic, multi angle observation of the disease, early diagnosis and differential diagnosis of biliary diseases. The first part of this study collected cases on the location of MSCT and non drinking low tension MSCT in the obstructive diseases of the biliary tract, and made a comparative study on the qualitative aspects. The second part was to compare and analyze the application of the three three-dimensional reconstruction methods of MPR, CPR and MinIP in the biliary tract obstruction disease. The third part of the third part is the analysis of the imaging features of the benign and malignant biliary tract lesions under the low tension of drinking water, the CT diagnosis and differential diagnosis of the biliary obstruction disease. The fourth part is the analysis of the patients with the low tension MSCT of drinking water and the data of the MRI MRCP, and the determination of MSCT and MRCP to the patients with biliary obstruction. Position, qualitative accuracy rate is compared.
The purpose of this study was to investigate the effect of drinking water low MSCT biliary tract imaging on the diagnosis of biliary obstructive diseases: To explore the diagnostic value of low tension MSCT technique in the diagnosis of biliary obstructive diseases. Methods 140 patients with obstructive jaundice with MSCT biliary tract imaging were randomly divided into two groups of low tension group and routine group, and 70 cases in low tension group were drinking water. Low tension MSCT biliary tract imaging; routine group 70 cases of routine MSCT biliary tract imaging. The two groups of imaging diagnosis results were compared with pathological or ERCP results, and the differences between the two groups were compared in the location and qualitative diagnosis. Results the accuracy of the third segments in the biliary tract was higher than that of the conventional group (x 2=4.09, P0.05), and the qualitative accuracy rate of the low tension group was higher than that of the normal group. Regulation group (x 2=6.73, P0.01). Conclusion drinking water hypotonic MSCT technology has certain advantages in the diagnosis of low level and malignant biliary obstructive disease.
Objective to study the application of two three-dimensional reconstruction technique in the low tension MSCT cholangio imaging of drinking water. Comparison of the application value of multiple three-dimensional reconstruction techniques in biliary obstructive diseases, the application value method of three-dimensional reconstruction method is multi plane reconstruction (MPR), surface reconstruction (CPR), minimum density projection (MinIP), and three three dimensional reconstruction techniques The application value of biliary obstruction was analyzed. Results there was no significant difference between the rank and test results of the three kinds of image quality. There was a statistical difference between the rank and test results of the three methods in meeting the diagnostic requirements. Three kinds of reconstruction methods were separately diagnosed and qualitative, and the highest correct rate of location diagnosis was MPR. conclusion in three three-dimensional reconstruction methods for biliary obstruction. It is MPR that has a high value in sexual diseases. Rational selection and utilization of three-dimensional reconstruction technology is a good complement to axial images and can provide more diagnostic value.
Analysis of the low tension MSCT manifestations of three good and malignant biliary obstruction diseases objective analysis of good bile duct and malignant disease in drinking water low MSCT, to explore the value of low tension MSCT in the diagnosis of biliary tract diseases. Methods 70 cases of biliary dilatation, degree and the end of the obstruction, morphology were statistically analyzed and the results of intrahepatic bile duct expansion were analyzed. Zhang Chengdu did not have statistical significance between the two groups (P? 0.05); the extent of choledochal dilatation was statistically significant between the two groups (P0.05), and there were statistical significance between the two groups of intrahepatic bile duct dilatation (P0.05). There were statistical significance between the two groups of the obstructive end form (P0.05). The lower obstruction was statistically significant (P0.05), suggesting low level obstruction. It is possible to show malignancy. In dynamic enhancement, the malignant tumor is different because of the different pathological types. Conclusion a careful comparison and analysis of the imaging features of benign and malignant biliary obstruction can improve the accuracy of MSCT diagnosis.
Study four the comparative study of low tension MSCT cholangiography and MRCP in drinking water objective to compare the significance of drinking water low tension MSCT and MRCP in the diagnosis of biliary obstructive diseases. Methods the location of low MSCT and MRCP of drinking water in 30 cases of biliary obstruction and the qualitative accuracy rate were compared. Results two kinds of examination methods were qualitatively and accurately located. Conclusion hypotonic MSCT in drinking water is a good alternative and complementary examination method for MRCP.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類(lèi)號(hào)】：R816.5
本文編號(hào)：2146495
本文鏈接：http://sikaile.net/yixuelunwen/yundongyixue/2146495.html
最近更新
教材專(zhuān)著
