256层螺旋CT曲面重建评估胆总管梗阻性病变

目的 探讨256层螺旋CT曲面重建（CPR）在胆总管梗阻性病变中的应用价值。方法 回顾性分析经手术病理证实的172例胆总管梗阻性病变患者的CT资料，患者接受256层螺旋CT平扫、多期增强扫描，后对图像进行CPR。以病理诊断结果为金标准，比较CT平扫+增强检查与联合CPR的诊断效能。结果 良性梗阻占74.42%（128/172），恶性梗阻占25.58%（44/172）；所有患者均表现为胆总管不同部位狭窄、中断及不同程度肝内外胆管扩张。CT平扫+增强定位诊断符合率为93.02%（160/172），低于联合CPR的95.93%（165/172），但差异无统计学意义（P=0.238）；CT平扫+增强定性诊断符合率为87.21%（150/172），低于联合CPR的95.35%（164/172）（P=0.007）。结论 256层螺旋CT平扫与多期增强联合CPR可提高胆总管梗阻性病变的定性诊断准确率，为临床提供更客观、准确的信息。

256-slice spiral CT curved planar reconstruction in evaluation of obstructive lesions of common bile duct

Objective To explore the application value of 256-slice spiral CT curved planar reconstruction (CPR) in obstructive lesions of common bile duct. Methods CT data of 172 patients with obstructive lesions of the common bile duct confirmed by surgical pathology were retrospectively analyzed, and patients underwent 256-slice spiral CT plain scan and multi-phase enhanced scanning, then CPR was performed on the images. With the pathological diagnosis result as the gold standard, the diagnostic efficacy of CT plain scan plus enhanced examination and plus CPR were compared. Results There were 74.42% (128/172) benign obstructive lesions and 25.58% (44/172) malignant obstructive lesions; all patients showed stenosis, interruption of different parts of common bile duct and dilation of intrahepatic and extrahepatic bile ducts in different degrees. The coincidence rate of localization diagnosis in CT plain scan plus enhanced was 93.02% (160/172), which was lower than that in combining with CPR (95.93% ), but there was no statistically significant (P=0.238). The coincidence rate of qualitative diagnosis in CT plain scan plus enhanced was 87.21% (150/172), which was lower than that in combining with CPR (95.35% , P=0.007). Conclusion 256-slice spiral CT plain scan and multi-phase enhancement combined with CPR can improve the qualitative diagnosis accuracy of obstructive lesions of common bile duct, and can provide more objective and accurate information for the clinic.