比较彩超与磁共振胰胆管成像诊断胆总管结石的临床价值

目的分析比较彩超与磁共振胰胆管成像(MRCP)检查诊断胆总管结石的价值。方法我院疑诊为胆总管结石患者102例,均接受彩超和MRCP检查。以手术后病理学检查为金标准,应用受试者工作特征曲线(ROC)下面积(AUC)计算诊断的灵敏度、特异度和Youden指数。结果在102例疑诊为胆总管结石患者中,经手术后病理学检查证实为胆总管结石90例;彩超检查发现单发结石39例(43.3%),多发结石25例(27.8%),而MRCP则分别检出46例(51.1%)和39例(43.3%),MRCP检查结石检出率为94.4%,显著高于彩超检查的71.1%(P<0.05);在直径>1.0 cm、0.5～1.0 cm和<0.5 cm结石,MRCP分别检出33例(36.7%)、45例(50.0%)和7例(7.8%),与彩超检查比,差异显著(分别为31例(34.4%)、32例(35.6%)和1例(1.1%,P<0.05);MRCP检出结石直径为(1.1～0.8)cm,显著小于彩超检出的(1.4～0.6)cm(P<0.05),而两种方法未检出的结石直径无显著性差异【分别为(0.8～0.2)cm和(0.6～0.4)cm,P>0.05】;彩超检查诊断的灵敏度为71.1%,特异度为75.0%,Youden指数为0.5,而MRCP检查诊断的灵敏度为94.4%,特异度为91.7%,Youden指数为0.9(P<0.05)。结论 MRCP较彩超检查能发现更小的胆总管结石,并能准确判断结石数量,诊断价值更高。

Comparison of magnetic resonance cholangiopancreatography with color Doppler ultrasound in diagnosis of patients with common bile duct stones

Objectiv The purpose of this study was to compare magnetic resonance cholangiopancreatography （MRCP） with color Doppler ultrasound （US） in diagnosis of patients with common bile duct stones. Methods 102 patients with suspected common bile duct stones were recruited in our hospital,and all of them were examined by color Doppler ultrasound and MRCP. The diagnostic efficacies between the two approaches were evaluated by area under the receiver-operating characteristic curve（AUC）. Results Out of the 102 patients with suspected choledocholithiasis,90 were diagnosed having common bile duct stones by post-operational pathology. The US demonstrated single stone in 39（43.3%） and multiple stone in 25（27.8%）,while the MRCP found them in 46（51.1%） and 39（43.3%）,respectively,with the detection rate of 94.4% by MRCP,significantly higher than 71.1%（P<0.05） by US;the detection rates by MRCP in stones with diameters of >1.0 cm,0.5-1.0 cm and <0.5 cm were 36.7%,50.0% and 7.8%,significantly different as compared to 34.4%,35.6% and 1.1% by US （P<0.05）;the diameters of stones showed by MRCP were （1.1~0.8）cm,much smaller than （1.4~0.6）cm by US （P<0.05）,while there was no significant difference between the diameters of undetectable stones by the two methods 【（0.8~0.2） cm vs.（0.6~0.4） cm,P>0.05】;the sensitivity,specificity and Youden's index by US were 71.1%,75.0% and 0.5,while they were 94.4%,91.7% and 0.9 by MRCP（P<0.05）. Conclusion MRCP is a sensitive approach in diagnosing common bile duct stones,which might help clinicians to make decisions.