64层螺旋CT胆道三维重建在胆道梗阻性疾病诊治中的应用

目的探讨64层螺旋CT非胆系增强法胆道三维重建在胆道梗阻性疾病的诊断及治疗方面的应用价值。方法对46例梗阻性黄疸的患者行64层螺旋CT扫描,扫描数据进行胆管三维重建,对梗阻原因进行定位、定性诊断,并与手术及病理结果进行对比分析。结果46例患者中31例胆道结石(其中30例与术中所见基本一致,1例胆总管下端阴性结石误诊为壶腹部肿瘤),定性、定位准确率分别为96·8%,100%;15例胆胰肿瘤患者中(9例胆管癌、1例胆囊癌、2例胰头癌、1例壶腹部癌、1例先天性胆总管囊肿),14例得到正确诊断,定性、定位正确率分别为93·3%,100%。总体定性、定位诊断正确率分别是95·7%、100%。结论64层螺旋CT胆道三维成像能够无创、清晰、立体显示胆管结构,提高术前对疾病的定性、定位诊断率,对胆道梗阻诊断有重要价值,并可进一步指导临床手术治疗。

Clinical value of reconstruction of three - dimensional biliary tract by 64 - slice spiral CT for the diagnosis of biliary obstruction disease

Objective To investigate the diagnostic and therapeutic value of 64-slice spiral CT negative helical CT cholangiography (N-CTC) and 3D reconstruction of the bile duct for biliary obstruction disease. Methods 64-slice CT scan data of 46 obstructive jaundice patients were used for reconstruction. Diagnosis of cause and location was derived from the reconstruction image and were compared with surgical and pathological findings.Results There were 31 patients with biliary calculi in 46 cases (of which 30 cases with intra-operative findings basically the same, one cases of distal common bile duct stones misdiagnosed as ampulla negative tumors). The qualitative and positioning accuracy rates were 96.8% and 100% respectively;In 15 patients with biliary and pancreatic tumors (9 cases of cholangiocarcinoma, 1 cases of gallbladder carcinoma, pancreatic cancer 2 cases, 1 ampullary cancer and 1 cases of congenital cysts), 14 cases were correctly diagnosed. The qualitative and positioning accuracy were 93.3% and 100% respectively. Qualitative and positioning accuracy rate were 95.7% and 100% respectively overall.Conclusion 64-slice CT 3D biliary imaging is noninvasive, clear and stereoscopic in displaying duct structure. It improves preoperative characterization of the disease, the diagnosis and surgical treatment of biliary obstruction.