【摘要】：目的 通過比較改良N-CTCP與常規(guī)N-CTCP對膽總管壺腹及周圍病變顯示程度,提高膽總管壺腹及周圍病變的CT顯示能力,為臨床提供更多的診斷基礎(chǔ)。通過64排SCT陰性法胰膽管成像與MRCP的定位及定性診斷率比較,分析改良N-CTCP在膽總管壺腹及周圍疾變的篩查、診斷中的應(yīng)用價值。 方法 1.收集我院2012年4月-2013年3月期間,臨床或其它影像懷疑為膽總管壺腹及周圍病變的患者21例,同時行常規(guī)及改良CT增強(qiáng)掃描,對兩次圖像根據(jù)-下7項(xiàng)指標(biāo)進(jìn)行比較：(病灶本身、病灶鄰近組織、十二指腸乳頭、膽總管下段管壁、管腔、胰管的顯示程度及十二指腸充盈程度),分析膽總管壺腹及周圍病變的CT顯示能力。 2.在病變獲得清晰顯示的基礎(chǔ)上,將同時行改良N-CTCP和MRCP的膽總管壺腹及周圍病變患者41例與手術(shù)病理和隨訪結(jié)果比較,分析兩種影像手段的定性及定位診斷準(zhǔn)確率。 結(jié)果 1.改良N-CTCP與常規(guī)N-CTCP病變顯示比較 (1)改良N-CTCP中低張和側(cè)臥(左側(cè)太高約45度)可清楚的觀察膽總管壺腹及其周圍病變與十二指腸降段的關(guān)系(是否原發(fā)或受累)。 (2)改良N-CTCP中提高對比劑濃度和流速可提高膽總管下段癌病灶與周圍組織的密度差,對觀察病變及周圍受累情況有重要意義。 (3)改良N-CTCP與常規(guī)N-CTCP病變顯示效果評分均數(shù)對比,數(shù)據(jù)經(jīng)SSPS13.0統(tǒng)計軟件分析,存在統(tǒng)計學(xué)差異(P0.05),即改良N-CTCP對病變顯示效果優(yōu)于常規(guī)N-CTCP。 2.改良N-CTCP與MRCP診斷正確率比較41例均經(jīng)隨訪或手術(shù)及病理組織學(xué)檢查確診,其中腫瘤及腫瘤樣病變共29例,炎癥性病變共7例,結(jié)石性梗阻5例：改良N-CTCP組及MRCP組定位均與病理結(jié)果一致,準(zhǔn)確率均為100%(41/41)；改良N-CTCP和MRCP定性準(zhǔn)確率分別為92.7%(38/41)和82.9%(34/41),改良N-CTCP準(zhǔn)確率較MRCP高,經(jīng)Wilocxon符號秩檢驗(yàn),P=0.279,(P0.05),即表明改良N-CTCP與MRCP定性準(zhǔn)確率無統(tǒng)計學(xué)差異。腫瘤及腫瘤樣病變29例,改良N-CTCP和MRCP定性準(zhǔn)確率分別為93.1%(27/29)和86.2%(25/29),兩者比較亦無統(tǒng)計學(xué)差異(P0.05),改良N-CTCP對炎癥性病變診斷正確率高于MRCP, MRCP對結(jié)石診斷正確率高于改良N-CTCP,但由于樣本量少,需要進(jìn)一步擴(kuò)大樣本量繼續(xù)研究。 結(jié)論 1.64排SCT陰性法胰膽管成像是一種簡單、快速、無創(chuàng)傷性的檢查手段,通過強(qiáng)大的圖像后處理技術(shù)可從不同角度顯示膽總管壺腹及周圍病變的部位、形態(tài)、范圍及其與周圍結(jié)構(gòu)的關(guān)系,可評估膽道擴(kuò)張程度,并可判斷病灶切除的可能性。 2.改良N-CTCP優(yōu)于常規(guī)N-CTCP對膽總管壺腹及其周圍病變的顯示效果,能夠更加清晰的顯示病變及鄰近組織,為圖像的后處理提供了前期準(zhǔn)備。 3.改良N-CTCP在膽總管壺腹及周圍病變的定位及定性準(zhǔn)確率與MRCP相當(dāng),并可以優(yōu)勢互補(bǔ),均是對膽總管壺腹及周圍病變相當(dāng)有效的檢查方法。 4.改良N-CTCP可以作為臨床疑診膽總管壺腹及周圍病變的常規(guī)檢查方法。
[Abstract]:objective
By comparing the display of ampullary ampulla and surrounding lesions of common bile duct with improved N-CTCP and conventional N-CTCP, improve the CT display ability of the ampulla of the common bile duct and the surrounding lesions, and provide more diagnostic basis for the clinical. The improved N-CTCP was analyzed by 64 rows of SCT negative cholangiopancreatography and the ratio of the location and qualitative diagnosis of MRCP to the ampullary and periampullary of the common bile duct. Screening of peri disease and the application value in diagnosis.
Method
1. we collected 21 cases of clinical or other imaging suspected of ampullary ampulla of common bile duct and surrounding lesions during March -2013 year of April 2012, and performed routine and modified CT enhanced scans and compared the two images according to the lower 7 indicators: the lesion itself, the adjacent tissue of the lesion, the duodenal papilla, the inferior duct wall of the common bile duct, the lumen, and the pancreatic duct The degree of display and the degree of duodenal filling were analyzed, and the CT display ability of the common bile duct ampulla and surrounding lesions was analyzed.
2. on the basis of a clear display of the lesions, 41 patients with ampullary and peripheral lesions of the common bile duct which were simultaneously modified with N-CTCP and MRCP were compared with the surgical pathology and follow-up results, and the accuracy of the qualitative and location diagnosis of the two imaging methods was analyzed.
Result
1. comparison of modified N-CTCP and conventional N-CTCP lesions
(1) the relationship between the ampullary ampulla of the common bile duct and the surrounding lesions of the common bile duct and the descending duodenal segment (whether primary or involvement) can be clearly observed in the modified N-CTCP middle low and lateral decubitus (too high about 45 degrees on the left side).
(2) improving the concentration and flow rate of the contrast agent in the improved N-CTCP can improve the density difference between the lesion of the lower segment of the common bile duct and the surrounding tissue, and it is of great significance to the observation of the lesions and the surrounding involvement.
(3) the scores of improved N-CTCP and conventional N-CTCP lesions were compared, and the data were analyzed by SSPS13.0 statistical software, and there was a statistical difference (P0.05). That is, the effect of improved N-CTCP was better than that of conventional N-CTCP..
2. the diagnostic accuracy of improved N-CTCP and MRCP were all confirmed by follow-up or operation and histopathological examination, including 29 cases of tumor and tumor like lesions, 7 cases of inflammatory lesions and 5 cases of stone obstruction: the modified N-CTCP group and MRCP group were all consistent with the pathological results, the accuracy rate was 100% (41/41), and the improved N-CTCP and MRCP were qualitative and accurate. The rate was 92.7% (38/41) and 82.9% (34/41), and the accuracy of improved N-CTCP was higher than that of MRCP. After Wilocxon symbol rank test, P=0.279, (P0.05), that was, there was no statistical difference between the improved N-CTCP and MRCP qualitative accuracy. 29 cases of tumor and tumor like lesions, 93.1% (27/29) and 86.2%, improved N-CTCP and MRCP, respectively. The diagnostic accuracy of improved N-CTCP for inflammatory lesions was higher than that of MRCP, and the correct rate of diagnosis of MRCP for stones was higher than that of modified N-CTCP (P0.05). However, there was a need to further expand the sample size for further study due to the small sample size.
conclusion
1.64 row SCT negative cholangiopancreatography is a simple, rapid, non traumatic examination. Through a powerful image post-processing technique, it can display the parts of the ampulla of the common bile duct and the surrounding lesions from different angles, the shape, the scope and the relationship with the surrounding structures, which can evaluate the extent of the biliary tract dilatation and determine the possibility of the resection of the lesions.
2. improved N-CTCP is better than conventional N-CTCP in displaying the ampullary ampulla of the common bile duct and its surrounding lesions. It can show the lesions and adjacent tissues more clearly, and provide early preparation for the post-processing of the image.
3. the localization and qualitative accuracy of modified N-CTCP in the ampullary ampulla and surrounding lesions of the common bile duct is equal to that of MRCP, and can complement each other. All of them are quite effective methods to examine the ampullary ampulla of the common bile duct and the surrounding lesions.
4. modified N-CTCP can be used as a routine examination method for suspected common bile duct ampulla and surrounding lesions.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R816.5

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