螺旋CT胰胆管阴性成像诊断胆管高位梗阻疾病

目的　探讨螺旋CT胰胆管阴性成像 (N CTCP)对胆管高位梗阻的评估能力。资料与方法　 4 0例胆管高位梗阻病例 (其中 15例作过PTC或ERCP检查 )使用血管对比剂 (阴性对比剂 )作了增强扫描。扫描数据经工作站后处理 ,用最小强度投影 (MinIP)和表面遮盖显示 (SSD)法获得N CTCP图像。采用盲法 ,分别就N CTCP图像质量、胆管显示能力、梗阻定位和定性诊断作出评价。结果　 4 0例中 ,N CTCP成功率达 95 .0 % (38/ 4 0 )。 38例中 ,MinIP像显示胆管能力平均为 4 .4度 ,SSD像 4 .1度 ;15例PTC或ERCP显示胆管能力平均为 3.0度 ,与对应MinIP、SSD像比较均有显著差异 (P <0 .0 1;P <0 .0 5 )。对照病理等结果 ,MinIP、SSD像定位准确率均为 97.4 % (37/ 38) ,定性准确率分别为 81.6 % (31/ 38)、73.7% (2 8/ 38)。结论　N CTCP定位准确率高 ,显示扩张胆管能力强 ,可为临床治疗提供较充分的信息

Negative Helical CT Cholangiopancreatography in the Diagnosis of High Obstruction of Bile Duct

Objective To evaluate negative helical CT cholangiopancreatography (N CTCP) in the diagnosis of high obstruction of bile duct.Materials and Methods Helical CT scanning, using negative vascular contrast, was performed in 40 patients with high obstruction of bile duct. N CTCP was obtained by using minimum intensity projection (MinIP) and surface shadow display (SSD) processing on a workstation. Additional PTC was carried out in 7 patients and ERCP in 8. Using blind method, the imaging quality, visualization of the bile duct, identification of the obstructed site and the nature of the obstruction were evaluated by two radiologists and one endoscopist.Results The successful rate of N-CTCP was 95.0% (38/40). The average grade for visualization of bile ducts for MinIP and SSD was 4.4 and 4.1, respectively, while the average grade for PTC and ERCP in 15 patients was 3.0, having a significant difference with MinIP (P<0.01) and SSD (P<0.05). Compared with the pathological results, the locating accuracy and qualitative accuracy for MinIP were 97.4% (37/38) and 81.6% (31/38), respectively, while for SSD were 97.4% (37/38) and 73.7% (28/38).Conclusion As a non invasive technique, N CTCP carries high accuracy in locating the obstruction and in judging the lesion's nature, providing the clinician with necessary information.