胰胆系疾病的影像学诊断对照研究

目的评价胰胆系疾病各种影像学检查方法的临床应用价值,并探讨其诊断最优化检查流程.方法对82例经手术病理证实的胰胆系疾病术前作诊断对照分析,其中胆石症38例、胰胆系肿瘤34例及其他病变10例.影像学检查包括B超、CT、逆行胰胆管造影(ERCP/PTC)、常规断面MRI检查及磁共振胰胆管成像(MRCP).结果MRCP对胰胆管梗阻的定位诊断正确率达100%,MRCP结合断面MRI检查对胰胆管梗阻的良、恶性鉴别诊断敏感度、特异度和正确率分别为82.3%、93.8%和89.0%,定性诊断正确率达87.8%,均显著高于B超(P＜0.01)和CT(P＜0.05)检查,而与直接胰胆管造影差异无显著性(P＞0.05).结论MRCP在多数情况下可替代诊断性的直接胰胆管造影,MRCP结合断面MRI检查是胰胆系疾病术前诊断、手术病例筛选及术后随访的重要手段.     

B超、CT与MRI诊断胆管结石对比分析

对比分析B超、CT与MRI各成像序列对胆管结石的诊断。选择收治的胆管结石患者25例,所有患者均行B超和MRI检查,其中12例行同期CT扫描。 MRI检出率达84%,CT检出率75%,B超检出率56%。 MRI检出率明显高于CT诊断,差异有统计学意义（P＜0.05）。对胆管结石进行诊断时,B超作为初步筛查法,而CT与MRI的诊断准确率较高。     

磁共振胰胆管造影结合多种MRI技术 在胰胆管疾病诊断中的价值

目的探讨磁共振胰胆管造影结合多种MRI技术对胰胆管疾病诊断的价值.方法对经手术病理或ERCP证实的胰胆管疾病患者100例,行包括冠状位T2加权、横断位T2加权、横断位T1加权、Turbo SE MRCP序列及HASTE MRCP序列的MRI检查.结果 MRCP对胰胆管疾病定性诊断准确率为91.0%;结合其他MR成像序列,定性诊断准确率为99.0%(χ2=6.7368, P<0.05).对胆系结石,Turbo SE MRCP检出率为94.9%,HASTE MRCP原始图像结合3D图像的检出率为98.7%;HASTE MRCP 3D图像检出率为84.6%,与Turbo SE MRCP之间存在显著差异(χ2=4.4572, P<0.05).结论 MRCP与其他MR成像技术结合应用,可准确判断梗阻部位,明确病变性质.     

磁共振胰胆管成像与常规扫描诊断胆系结石的对照研究

目的：对比探讨磁共振胰胆管成像及其原始图像与磁共振常规扫描诊断胆系结石的价值。方法：应用1．0T超导MRI扫描仪对55例患者（36例胆囊结石和19例胆总管结石）行重T2加权多次激发FSE序列（HT2-FSE）磁共振胰胆管成像扫描及常规轴面FSE序列MRI T1WI及T2WI扫描。结果：磁共振胰胆管成像的最大强度投影图像能清晰显示肝内、外胆管及扩张胰管的形态结构。多数较大的胆系结石在磁共振胰胆管成像原始图像及MRI常规T2WI图像上可很好地显示，但常在最大强度投影图像被掩盖；较小的胆系结石在磁共振胰胆管成像的最大强度投影图像及MRI常规T2WI图像均难以准确显示，而仅在磁共振胰胆管成像原始图像上显示。结论：磁共振胰胆管成像原始图和最大强度投影图像以及磁共振常规扫描是分析、诊断胆系结石的一个有机整体，不能仅仅依靠某一种成像技术作出诊断。     

MRI-FIESTA成像序列对胆道结石的诊断价值

目的评价磁共振FIESTA序列对胆道系统结石的诊断价值。方法搜集30例CT诊断为肝内胆管结石患者,其中14例伴肝外胆管结石(肝总管6例,胆总管结石8例),均行磁共振胰胆管水成像(MRCP)检查,同时对兴趣区分别行薄层FRFFSE-T_2WI脂肪抑制序列及FIESTA脂肪抑制序列扫描检查,比较两组对结石的诊断符合率。所有病例后均经手术或ERCP证实。结果 30例胆内胆管结石,MRCP+FRFFSE组阳性19例,符合率63%;MRCP+FIESTA组阳性26例,符合率87%,两者肝内结石符合率差异有统计学意义(P0.05);而肝外胆管结石,MRCP+FRFFSE组阳性15例,其中假阳性1例,MRCP+FIESTA组阳性14例,两者符合率均近100%,肝外结石符合率无明显差异性。结论 FIESTA序列对胆道结石尤其是肝内结石有极高的临床诊断价值。     

磁共振胰胆管成像与B超检查诊断胆系结石的对照研究

目的：对比探讨磁共振胰胆管成像（MRCP）与B超检查诊断胆系结石的价值.方法：应用1．0T超导MRI扫描仪对57例患者（38例胆囊结石和19例胆总管结石）行重L加权多次激发FSE序列（HT2-FSE）MRCP扫描及常规B超检查。结果：尽管MRCP的最大密度投影（MIP）图像能清晰显示肝内、外胆管及扩张胰管的形态结构，但多数较大的胆系结石常在MIP图像被掩盖；较小的胆系结石在MRCP的MIP图像上均难以准确显示．而仅在B超检查图像上显示。但对于19例胆总管结石，B超仅可显示其中的9例（47％）。结论：由于MIP重建技术的固有特性，MRCP的MIP图像易遮盖结石所致的低信号充盈缺损，因而对于胆系结石的诊断．应有机地结合MRCP与B超检查，不能仅仅依靠某一种成像技术作出诊断     

总胆管结石B超检查与结果的对比分析

目的：探讨总胆管结石B超诊断的敏感性、特异性、准确性。方法：对B超诊断的53例总胆管扩张及结石的声像图诊断结果，与内窥镜逆行胰胆管造影(ERCP)结果对照。结果：B超检出的总胆管结石的敏感性69％，特异性91％，准确性74％。结论：B超诊断总胆管上段结石的符合率较高，对总胆管下段，特别是壶腹部结石易造成假阴性；B超与ERCP两可以取长补短，弥补不足。     

常规MRI扫描结合胰胆管造影在胆道梗阻性疾病中的应用

目的 探讨常规MRI扫描及胰胆管造影(MRCP)对胆管梗阻性疾病的临床诊断价值.方法 2006年4月-2010年6月,对59例胆管梗阻性疾病患者行常规MRI及MRCP检查,其中18例行动态增强扫描,并与临床诊断或手术、病理结果对照分析.MRCP采用不屏气厚层快速自旋回波(FSE)序列重度T2WI扫描,原始图像以最大信...     

MRI与CT诊断肝外胆管结石的临床效果对比分析

目的：分析MRI与CT诊断肝外胆管结石的临床效果。方法：选取2022年1月—2023年3月肥西县人民医院收治的37例疑似肝外胆管结石患者为研究对象,患者均接受CT和MRI检查,以消化内镜逆行性胰胆管造影检查结果为金标准,统计CT和MRI诊断的结果,比较CT及MRI的诊断效能。结果：消化内镜逆行性胰胆管造影检查结果显示,37例疑似肝外胆管结石患者中,阳性33例,阴性4例;CT检查结果显示真阳性21例,假阳性3例,真阴性1例,假阴性12例;MRI检查结果显示,真阳性30例,假阳性1例,真阴性3例,假阴性3例;MRI检查灵敏度、特异度、准确率、阳性预测值、阴性预测值均高于CT检查,差异有统计学意义（P <0.05）。结论：MRI检查用于肝外胆管结石诊断价值较高,可为医生临床治疗方案的制定提供有效依据。     

磁共振胰胆管成像技术的临床应用

目的探讨磁共振胰胆管成像(MRCP)对胆道梗阻性疾病的临床应用价值.方法通过对52例梗阻性黄疸患者术前行MRCP检查,同时对比US、CT、直接胰胆管造影及手术病理结果对照分析,评价胆道梗阻性疾病的影像学对比研究.结果 52例MRCP检查均一次成功,胰胆管显示满意,其效果类似于直接胰胆管造影图像.MRCP可显示各种良恶性胆道梗阻性病变影像学特征,对梗阻程度判断和定位诊断准确率为100%,定性诊断准确率为88.4%.结论 MRCP成像技术为重T2WI扫描,检查成功率高,胰胆管显示清晰,对各种梗阻性黄疸的临床应用适应证广泛,与常规MRI结合能提高胰胆管梗阻性疾病的影像学诊断水平.     

胆道疾病的影像检查(附486例报告)

目的 评价各种影像检查方法在胆道疾病诊断中的价值。方法 回顾性复习486例经手术病理证实的胆道疾病影像资料,分析各检查方法的优势和局限性。结果 26例胆囊内阴性结石在传统造影中显示清楚。胆道直接造影能清楚显示胆道解剖形态及病因。B超和CT对胆道结石诊断阳性准确率为91.3%和90.3%,13例泥沙样胆石CT漏诊。超声诊断慢性胆囊炎和胆囊息肉符合率达100％和93.3%。MRCP的“胆管树”有助于肝门胆管癌的确诊。结论 传统造影法能较好显示胆囊阴性结石,胆道直接造影为定性诊断提供重要依据。B超和CT显示胆道结石优于其他方法。超声是慢性胆囊炎和息肉样病变最好检查方法。MRCP是诊断重度胆道梗阻的理想影像手段。     

婴幼儿泌尿系三聚氰胺结石影像检查特点

目的探讨婴幼儿泌尿系三聚氰胺结石的影像特点,总结不同影像检查的诊断价值。方法回顾分析17例婴幼儿泌尿系三聚氰胺结石的腹部平片、螺旋CT平扫和泌尿系超声检查表现,与7例非三聚氰胺结石病例的影像表现进行对照分析。结果17例三聚氰胺结石病例中,多发结石者8例,形态多不规则,CT值较对照组低,超声声像图显示结石强回声光团后方多伴淡声影或无声影。同时行腹部螺旋CT平扫和超声检查的病例中,2例CT发现的结石数量多于超声检查。结论三聚氰胺结石的影像特点为多发、体积小、密度低且形态不规则;腹部螺旋CT平扫对结石性状、数量及并发症的检出高于超声检查。     

18F-脱氧葡萄糖-正电子发射型体层摄影术显像诊断鼻咽癌放疗后残留病灶的价值

目的：探讨^18F-脱氧葡萄糖（FDG）-正电子发射型体层摄影水（PET）在鼻咽癌放疗后残留病灶中的诊断价值。方法：分析2003年1月至2005年12月间在本院治疗的36例鼻咽癌患者。所有患者放疗后行PET或MRI／CT检查，依据病理或随访结果对残留病灶进行定性评价。结果：36例患者中，PET显示异常浓聚、诊断为病灶残留的有23例，而MRI／CT为18例，PET诊断病灶残留的灵敏度和假阳性率分别为91．5％和8．7％，而MRI／CT分别为77．3％和22、2％。结论：^18F-FDG-PET对鼻咽癌放疗后残留病灶的判断较MRI／CT准确。     

超声造影在肝外胆管占位性病变中的应用

目的 探讨应用CEUS诊断肝外胆管占位性病变的价值。方法 回顾性分析45例因肝外胆管占位性病变就诊于我院的患者, 将二维超声(US)、CEUS及增强CT影像学诊断结果与患者病理诊断进行对比, 分析每种影像学方法的诊断效能。结果 45例病例中良性病变6例, 恶性病变39例。US、CEUS及增强CT对肝外胆管良恶性病变的诊断准确率分别为71.11%(32/45)、88.89%(40/45)及91.11%(41/45), US与CEUS间(P=0.035)、US与增强CT间(P=0.015)差异具有统计学意义, CEUS与增强CT间(P=1.000)差异无统计学意义。结论 CEUS对肝外胆管占位性病变的诊断准确率高于US, 与增强CT相近, 对肝外胆管占位性病变的临床诊断具有重要价值。     

Can plain film radiography improve the emergency department detection of clinically important urinary stones?

ObjectivePhysicians frequently use ultrasound to assess hydronephrosis in patients with suspected renal colic, but ultrasound has limited diagnostic sensitivity and rarely clarifies stone size or location. Consequently, up to 80% of emergency department (ED) renal colic patients undergo confirmatory CT imaging. Our goal was to estimate x-ray sensitivity for urinary stones and determine whether x-ray substantially improves stone detection (sensitivity) compared to hydronephrosis assessment alone.MethodsWe reviewed imaging reports from all renal colic patients who underwent x-ray and CT at four EDs. For each patient, we documented stone size, location and hydronephrosis severity on CT and whether stones were identified on x-ray. We considered moderate and severe hydronephrosis (MS-Hydro) as significant positive findings, then calculated the sensitivity (detection rate) of MS-Hydro and x-ray for large stones ≥5 mm and for stones likely to require intervention (all ureteral stones >7 mm and proximal or middle stones >5 mm). We then tested a diagnostic algorithm adding x-ray to hydronephrosis assessment.ResultsAmong 1026 patients with 1527 stones, MS-Hydro sensitivity was 39% for large stones and 60% for interventional stones. X-ray sensitivity was 46% for large stones and 52% for interventional stones. Adding x-ray to hydronephrosis assessment increased sensitivity in all stone categories, specifically from 39% to 68% for large stones (gain = 29%; 95%CI, 23% to 35%) and from 60% to 82% for interventional stones (gain = 22%; 95%CI, 13% to 30%). Because CT and ultrasound show strong agreement for MS-Hydro identification, physicians who depend on ultrasound-based hydronephrosis assessment could achieve similar gains by adding x-ray.ConclusionsAdding x-ray to hydronephrosis assessment substantially improves diagnostic sensitivity, enabling the detection of nearly 70% of large stones and over 80% of interventional stones. This level of sensitivity may be sufficient to reassure physicians about a renal colic diagnosis without CT imaging for many patients.     

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

  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。      

Evaluation of the patients with flank pain in the emergency department by modified STONE score

Background/AimComputed tomography (CT) is generally used for ureteral stone diagnosis. Unnecessary imaging use should be reduced to prevent increased radiation exposure and lower costs. For this reason, scoring systems that evaluate the risk of ureteral stones have been developed. In this study, we aimed to investigate the diagnostic accuracy of the modified STONE score (MSS) and its ability to predict ureteral stones.Materials and methodsThe research was conducted as a multi-center, prospective and observational study. Patients aged 18 and over who presented to EDs with complaints of flank pain and who received a CT were included. Patients were divided into two groups based on the presence or absence of stones, and the categories of the MSS were determined. The ability of the MSS to predict the ureteral stone and its diagnostic accuracy were calculated.ResultsThe median age (min/max) of the 367 study patients was 37 (18/91), and 244 (66.5%) were male. A ureteral stone was present in 228 (73.0%) patients. Male gender, previous stone history, duration of pain less than 6 h, presence of hematuria, and CRP value below 0.5 mg/dL were significantly more common in the group with stones. The prevalence of ureter stones in the MSS high-risk group was 96.0%. The area under the receiver operating characteristic curve and sensitivity of the MSS was 0.903 and 0.81, respectively.ConclusionThe modified STONE score has high diagnostic performance in suspected urinary stone cases. This scoring system can assist clinicians with radiation reducing decision-making.     

胆系结石症的CT诊断及影像学分析

目的：探讨胆系结石症的CT检查方法及影像对比。材料与方法：52例胆系结石症使用口服白开水后CT平扫,必要时进行静脉胆系造影后CT平扫。结果：单纯胆囊结石27例,胆总管结石10例,肝内胆管结石8例,多部位结石7例。CT对胆系微小结石,胆总管下段结石显示率优于B超。结论：口服白开水后CT平扫或静脉胆系造影后CT平扫是诊断胆系结石症的最佳影像学检查方法。根据结石的位置、大小、密度、数目等对临床治疗有重要参考价值。     

SpyGlass直视化系统在胆管疾病诊断和治疗中的应用*

目的评估SpyGlass直视化系统在不明性质胆管疾病诊断以及复杂胆管结石治疗中的效果。方法回顾性分析2015年1月-2017年12月该中心采用SpyGlass直视化系统诊断和治疗的连续108例胆管疾病患者的临床资料。SpyGlass直视化系统诊断和治疗的措施包括:SpyGlass直视化系统检查,SpyGlass直视化系统引导下活检和SpyGlass直视化系统取石。SpyGlass直视化系统诊断及治疗成功的评价指标包括:目标病变充足的可视化,SpyGlass直视化系统引导下完成充足的组织取样,以及结石的彻底清除。结果共计108例患者纳入该研究,76(70.4%)应用SpyGlass直视化系统进行诊断,32例(29.6%)行结石的治疗。诊断及治疗总成功率89.8%(97/108);其中68例顺利通过SpyGlass直视化系统完成诊断,诊断成功率89.5%(68/76);29例在SpyGlass直视化系统引导下完成结石的彻底清除,治疗成功率90.6%(29/32);并发症发生率10.2%(11/108)。结论 SpyGlass直视化系统通过到达病变组织进行直视化观察和充足取样,提高了不明性质胆管病变诊断的准确率,同时SpyGlass直视化系统联合各种取石、碎石设备直视下清除结石,提高了复杂胆管结石治疗的成功率。     

Fascioliasis: US, CT, and MRI findings with new observations

Background: The purpose of this study is to describe the ultrasonographic (US), computed tomographic (CT), and magnetic resonance imaging (MRI) findings in fascioliasis and to emphasize the impact of radiology in diagnosis. Methods: Radiologic findings in 23 consecutive patients with fascioliasis were prospectively recorded. All patients had at least one US and CT examination, and 10 of them were studied by MRI. All diagnoses were confirmed by serologic methods. In the first three cases, initial diagnosis was reached by microscopic demonstration of the parasites' eggs in bile obtained by US-guided gallbladder aspiration. Results: In the hepatic phase of fascioliasis, multiple, confluent, linear, tractlike, hypodense, nonenhancing hepatic lesions were detected by CT. On US, the parasites could be clearly identified in the gallbladder or common bile duct as floating and nonshadowing echogenic particles. MRI showed the lesions as hypo- or isointense on T1-weighted images and as hyperintense on T2-weighted images. Conclusions: CT findings in the hepatic phase and US findings in the biliary phase are characteristic of fascioliasis. Because clinical and laboratory findings of fascioliasis may easily be confused with several diseases, radiologists should be familiar with the specific radiologic findings of the disease to shorten the usual long-lasting diagnostic process. Received: 15 December 1999/Accepted: 26 January 2000