| 磁共振胰胆管成像与弥散加权成像联合CT增强扫描对恶性胆道梗阻的诊断价值 |
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| 作者姓名： | 杨毅 韩鸿宇 陈欢 郝璐 |
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| 作者单位： | 新疆医科大学第二附属医院医学影像科，新疆 乌鲁木齐 830000 |
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| 基金项目： | 新疆维吾尔自治区自然科学基金2019D01C184 |
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| 摘 要： | 目的 分析探讨磁共振胰胆管成像(MRCP)与弥散加权成像(DWI)联合CT增强扫描对恶性胆道梗阻的定位定性诊断价值。 方法 选择2015年6月~2020年12月在我院收治的疑似恶性胆道梗阻患者80例，所有患者均接受MRCP、DWI、CT增强扫描检查与病理学诊断; 以病理学诊断为“金标准”，对比所有患者MRCP形态，比较MRCP+DWI单独检查与CT增强扫描检查对胆道梗阻定位、定性诊断价值。 结果 病理组织学结果显示，80例患者中良性肝外胆道梗阻患者33例(41.25%)，其中胆管结石27例，胆管炎性狭窄6例; 恶性肝外胆道梗阻患者47例，占比58.75%，其中胆总管癌34例、壶腹癌4例、胰头癌9例; MRCP影像学特征显示，良性梗阻患者主要表现为“枯枝状”，恶性梗阻患者主要表现为“软藤状”; 两种检测方法中，MRCP+DWI联合CT增强扫描对胆道梗阻的定位诊断准确率高于MRCP+DWI诊断(P < 0.05);MRCP+DWI检查胆道梗阻对胆管结石、胆管炎性狭窄、胆管癌、胰头癌的诊断符合率均低于MRCP+DWI联合CT增强扫描，两种检查方法对壶腹癌的诊断符合率均为100%;MRCP+ DWI联合CT增强扫描定性诊断总符合率高于MRCP+DWI检查(P < 0.05)。 结论 MRCP+DWI联合CT增强扫描可对恶性胆道梗阻进行准确定位，还可提高定性诊断恶性胆道梗阻的准确率，值得临床推广使用。
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| 关 键 词： | 磁共振胰胆管成像 弥散加权成像 CT增强扫描 恶性胆道梗阻 定位诊断 定性诊断 |
| 收稿时间： | 2022-06-17 |
Value of localization and qualitative diagnosis of malignant biliary obstruction by MRCP+DWI combined with enhanced CT scan |
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| Authors: | YANG Yi HAN Hongyu CHEN Huan HAO Lu |
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| Affiliation: | Department of Medical Imaging, Second Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, China |
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| Abstract: | Objective To investigate the value of localization and qualitative diagnosis of malignant biliary obstruction by magnetic resonance cholangiopancreatography (MRCP) and diffusion-weighted imaging (DWI) combined with enhanced CT. Methods Patients with suspected malignant biliary obstruction admitted to our hospital from June 2015 to December 2020 were selected. All patients received MRCP, DWI, CT enhanced scanning examination and pathological diagnosis. We took pathological diagnosis as the "gold standard", and the morphology of MRCP in all patients was compared. The value of MRCP+ DWI alone and enhanced CT scan in the localization and qualitative diagnosis of biliary obstruction were compared. Results Histopathological results showed that among the 80 patients, 33 (41.25%) had benign extrahepatic biliary obstruction, including 27 bile duct stones, 6 cholangitis strictures. There had 47 malignant extrahepatic biliary obstruction, accounting for 58.75%, including 34 cases of bile total duct cancer, 4 cases of ampullary carcinoma, and 9 cases of pancreatic head carcinoma. MRCP imaging features showed that patients with benign obstruction were mainly "withered branches shape", and patients with malignant obstruction were mainly "soft vine shape". Among the two detection methods, MRCP + DWI combined with enhanced CT scanning had higher accuracy in diagnosing biliary obstruction than MRCP + DWI (P < 0.05). The diagnostic coincidence rates of MRCP + DWI for biliary obstruction in bile duct stones, cholangitic stenosis, cholangiocarcinoma, and pancreatic head cancer were lower than those for MRCP + DWI combined with enhanced CT scanning. The diagnostic coincidence rate of the two methods for ampullary carcinoma was 100%. The overall coincidence rate of qualitative diagnosis of MRCP + DWI combined with enhanced CT scan was higher than that of MRCP + DWI (P < 0.05). Conclusion MRCP + DWI combined with enhanced CT scanning can accurately locate malignant biliary obstruction and improve the accuracy of qualitative diagnosis of malignant biliary obstruction. |
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