三种影像学方法诊断肝外胆管结石比较研究

目的 探讨采用超声、腹部CT和磁共振胆管成像(MRCP)诊断肝外胆管结石的效能。方法 2017年3月～2019年2月在我院治疗的肝外胆道梗阻性病变患者107例,术前行腹部超声、CT和MRCP检查,以术后病理学检查为金标准,采用ROC曲线分析腹部超声、CT和MRCP诊断肝外胆管结石的效能。结果 本组病例经手术后病理学检查,诊断肝外胆管结石59例;超声、CT和MRCP诊断结石分别为64.4%、67.8%和84.7%(P<0.05);对于直径≤8 mm的结石,MRCP的诊断率为80.0%(32/40),显著高于超声诊断的60.0%(24/40)或腹部CT诊断的57.5%(23/40),MRCP对结石的定位准确率为84.8%(50/59),也显著高于超声检查的66.1%(39/59)或腹部CT检查的67.8%(40/59,P<0.05);MRCP诊断的灵敏度、特异度和准确率分别为84.8%(50/59)、89.6%(43/48)和86.9%(93/107),显著高于超声检查【分别为64.4%(38/59)、83.3%(40/48)和72.9%(78/107),P<0.05】或腹部CT检查【分别为67.8%(40/59)、81.3%(39/48)和73.8%(79/107),P<0.05】。结论 MRCP诊断肝外胆管结石的效能较高,优于腹部CT或超声检查,尤其是对直径≤8 mm的小结石,应该引起重视。

Diagnostic efficacy of ultrasonography,CT and MRCP in the diagnosis of extrahepatic bile duct stones

Objective The aim of this study was to explore the diagnostic efficacy of ultrasonography,CT and magnetic resonance cholangiography(MRCP)in the diagnosis of extrahepatic bile duct stones.Methods A total of 107 patients with extrahepatic biliary obstruction were recruited in our hospital between March 2017 and February 2019,and all of them underwent abdominal ultrasonography,CT scan and MRCP.The diagnosis was confirmed by pathological examination.The diagnostic sensitivity,specificity and accuracy by abdominal ultrasound,CT and MRCP for diagnosis of stones were analyzed by ROC curves and the area under the ROC curve(AUC).Results Out of our 107 patients with extrahepatic biliary obstruction,59 were diagnosed as with extrahepatic bile duct stones by post-operational pathological examination and the diagnostic rates by ultrasonography,CT and MRCP were 64.4%,67.8%and 84.7%(P<0.05);as to the stones less than 8 mm,the diagnostic rate by MRCP was 80.0%(32/40),significantly higher than 60.0%(24/40)by ultrasonography or 57.5%(23/40)by CT scan,and the accuracy of positioning stones by MRCP was 84.8%(50/59),also much higher than 66.1%(39/59)by sonography or 67.8%(40/59,P<0.05)by CT scan;the diagnostic sensitivity,specificity and accuracy by MRCP were 84.8%(50/59),89.6%(43/48)and 86.9%(93/107),significantly higher than64.4%(38/59),83.3%(40/48)and 72.9%(78/107)by sonography(P<0.05)or 67.8%(40/59),81.3%(39/48)and 73.8%(79/107)by CT scan(P<0.05).Conclusions The diagnostic efficacy of MRCP in detecting extrahepatic bile duct stone is superior to ultrasonography or abdominal CT scan,especially for stones less than 8 mm,which has a very practical roles in clinical practice.