MRI、MRCP结合血清CA199对低位性胆道梗阻的鉴别诊断价值

目的探讨MRI、MRCP征象结合血清CA199检测对低位性胆道梗阻的鉴别诊断价值。方法搜集我院经手术或临床证实的低位性胆道梗阻并同时进行血清CA199检测的患者51例。分析比较良恶性梗阻的MRI、MRCP征象及血清CA199水平。结果(1)低位性胆道梗阻恶性组与良性组间的血清CA199水平差异具有统计学意义(P=0.000)。(2)恶性组肝内胆管中重度扩张者占88.9%,良性组轻中度扩张者占87.8%,两组间轻度及重度扩张的差异具有统计学意义(P=0.001,P=0.009);(3)恶性组肝内胆管扩张呈软藤状者占55.6%,而良性组呈枯枝状者占87.8%,二者之间的差异具有统计学意义(P=0.045);(4)恶性组胆总管下端表现为杵状或菜花状改变者占44.4%;良性组胆总管末端表现逐渐变细者占72.7%,但除菜花状改变两组间的差异具有统计学意义外,其余两种征象间差异均无统计学意义;(5)胆囊增大及胰管扩张在良恶性组间的差异无统计学意义。结论MRI及MRCP能较清楚的显示低位性胆道梗阻的影像征像,结合血清CA199水平对低位性胆道梗阻的鉴别诊断准确率可达100%,具有较高的临床应用价值。

The Differentiating Values of Low Level Biliary Obstruction with MRI and MRCP Combined with CA199

【Objective】 To evaluate valves of MRI and MRCP signs combined with serum CA199 in differentiate diagnosis of low level biliary obstruction.【Methods】 and Methods MRI and MRCP feature combined with serum CA199 of 51 cases with malignant and benign low level biliary obstruction were retrospectively analyzed.All the cases were confirmed by surgery and pathology or clinic therapy.【Results】（1） The serum level of CA199 in malignant group of low level biliary obstruction was significantly higher than of benign one（P=0.000）.（2） The moderate and severe dilation of intra-hepatic bile tract in malignant group was 88.9%,while the moderate and slight dilation of benign one was 87.8%.The significant difference in the severe dilation and slight dilation were found between malignant group of low level biliary obstruction and benign one（P=0.001,P=0.009）.（3）The soft ratten-like sign of intra-hepatic bile tract dilatation in malignant group was 55.6% and withered sign in the benign one was 87.8%.The significant difference was found between them（P=0.045）.（4） The clubbed or cauliflower-like sign of the inferior of common bile duct in malignant group of low level biliary obstruction was 44.4% and the gradual thinning sign in the benign one was 72.7%,but no significant difference was found between them except cauliflower-like sign.（5） No significant difference in gallbladder expansion and pancreatic duct dilation was found between the malignant group of low level biliary obstruction and the benign one.【Conclusion】 MRI and MRCP can display signs of the low level biliary obstruction in distinctly.Combined with serum level of CA199,the diagnostic accuracy for low level biliary obstruction will be 100%.