【作者】 刘新立；

【导师】 刘文亚；

【作者基本信息】 新疆医科大学 ， 影像医学与核医学， 2009， 硕士

【摘要】 目的:探讨多层螺旋CT(MSCT)联合阴性法胆道成像(N-CTC)对胆道梗阻性疾病的诊断价值;比较和评价MSCT/N-CTC与磁共振(MR)/胰胆成像(MRCP)对胆道梗阻的定性诊断价值的一致性。方法:连续收集60例怀疑胆道梗阻的病例进行MSCT扫描及N-CTC胆道成像;其中49例胆道梗阻的病例于一周内同时行MSCT扫描、MR及MRCP检查。N-CTC以曲面重建(curved planar reformation,CPR)技术和最小密度投影(minimum intensity projection,Min-IP)技术进行图像重建;MRCP以最大强度投影(maximum intensity projection,MIP)技术和容积再现(volume rendering,VR)技术进行图像重建。将影像学诊断结果与手术和/或病理结果对照,计算60例病例的灵敏度、特异度、准确率、预测值和似然比来评价MSCT/N-CTC对胆道梗阻定位、定性的诊断价值;49例病例组以受试者工作特性(ROC)曲线下面积Az及Kappa指数来评价MSCT/N-CTC与MR/MRCP定性诊断的一致性。结果:所有纳入病例均顺利完成影像检查,胆道显示满意,MSCT轴位像结合CPR及Min-IP重建图像对胆道梗阻的定位和定性诊断的灵敏度分别为89.86%和88.64%,特异度分别为94.59%和81.25%,准确率分别为92.78%和86.67%,阳性预测值分别为91.18%和92.86%,阴性预测值分别为93.75%和72.22%,阳性似然比分别为16.61和4.73,阴性似然比分别为0.11和0.14。MSCT/N-CTC与MR/MRCP定性诊断的Az分别为0.9423及0.9448,P值为0.44>0.05。Kappa指数为0.8494,(α=0.05)。结论:N-CTC结合轴位图像对胆道梗阻性疾病的定位、定性有较高准确性,定性诊断与MR/MRCP比较有较好的一致性。MSCT/N-CTC是较实用的无创性胆道检查方法。更多还原

【Abstract】 Objective: To evaluate the value of MSCT combined negative CT cholangiography (N-CTC) in diagnosis of bile duct obstructive disease,and to compare the MSCT/ N-CTC with MR/ MR cholangiopancreatography (MRCP) in differential diagnosis of bile duct obstruction.Methods: Consecutive 60 cases suspected of bile duct obstruction were underwent MSCT scan. 49 cases of bile duct obstruction underwent MSCT and MR scan simultaneously. Curved planar reformation(CPR) and minimum intensity projection(Min-IP) were used in N-CTC,while maximum intensity projection(MIP) and volume rendering (VR) were used in MRCP. Combined with their multi-axial and multi-sequence image to reveal the diseases. The imaging results were compared with that of surgical / pathology. The reference index for evaluation of MSCT/ N-CTC include sensitivity(SEN),specificity(SPE),accuracy(ACC), predictive value (PV) and likelihood ratio (LR). Consistency of MSCT/ N-CTC correlated with MR/ MRCP were the area under the receiver operating characteristic(ROC)curve (Az) and Kappa index . Results: All patients were examined smoothly and showed bile ducts obstruction. The SEN, SPE,ACC, positive predictive value (PPV),negative predictive value (NPV),positive likelihood ratio (PLR) and negative likelihood ratio (NLR) to determine the location and disease of obstruction of bile duct were SEN 89.86% and 88.64%, SPE 94.59% and 81.25%,ACC 92.78% and 86.67%, PPV 91.18% and 92.86%,NPV 93.75% and 72.22%, PLR 16.61 and 4.73,NLR 0.11 and 0.14, respectively. Az of MSCT/ N-CTCP and MR/ MRCP were 0.9423 and 0.9448 respectively,P=0.44>0.05. Kappa index of MSCT/ N-CTC compared with MR/ MRCP was 0.8494,(α=0.05).Conclusions: MSCT/N-CTC can accurately determine the location of bile duct obstruction and make clear the reason. It is a very potential non-invasive method to detect the bile duct obstructive and diagnose the disease.更多还原