多层螺旋CT与磁共振MRCP技术诊断胆总管结石价值分析

目的分析多层螺旋CT与磁共振胰胆管造影技术(MRCP)诊断胆总管结石的临床价值。方法选取2015年3月至2019年3月于我院收治的146例疑似胆总管结石患者作为研究对象,对以上患者均行多层螺旋CT、MRCP和内镜逆行胰胆管造影(ERCP)检查,并以ERCP检查结果作为"金标准",分析多层螺旋CT和MRCP对胆总管结石患者的影像表现和诊断结果,并计算两种检查方法的敏感度、特异度、准确率、阳性预测值、阴性预测值与ERCP结果的kappa值以及不同结石大小的准确率。结果146例患者中,经ERCP诊断出胆总管结石患者112例,非结石患者34例;经多层螺旋CT诊断出阳性102例,阴性44例;MRCP诊断出阳性109例,阴性37例;MRCP诊断胆总管结石患者的灵敏度、准确率均明显高于多层螺旋检查(P<0.05),且MRCP诊断与病理诊断的Kappa值为0.870,大于多层螺旋CT诊断与病理诊断的Kappa值0.716;同时,两种检查方法诊断直径>1.0cm结石的准确率均高于诊断直径<0.5cm结石的准确率(P<0.05)。结论相比多层螺旋CT检查,MRCP诊断胆总管结石的灵敏度和准确率较高,与ERCP"金标准"诊断结果具有较好的一致性,临床应用价值较高。且两种检查方法均对直径>1.0cm结石具有较高的检出准确率。

Diagnostic Value of Multi-slice Spiral CT and MRCP in Common Bile Duct Stones

Objective To analyze clinical value of multi-slice spiral CT(MsCT)and magnetic resonance cholangiopancreatography(MRCP)in diagnosis of common bile duct stones(CBDs).Methods A total of 146 patients with suspected CBDs who were admitted to the hospital from March 2015 to March 2019 were enrolled as study objects.All underwent MsCT,MRCP and endoscopic retrograde cholangiopancreatography(ERCP).Taking ERCP results as"golden standard",imaging findings and diagnostic results of MsCT and MRCP in CBDs patients were analyzed.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the two methods,their kappa values with ERCP results,and accuracy rates for diagnosis of stones with different sizes were calculated.Results Among 146 patients,ERCP diagnosis showed that there were 112 cases with CBDs,and 34 cases without stones.MsCT diagnosis showed that there were 102 cases positive,and 44 cases negative.MRCP diagnosis showed that there were 109 cases positive,and 37 cases negative.The sensitivity and accuracy of MRCP for diagnosis of CBDs patients were significantly higher than those of MsCT(P<0.05),Kappa value between MRCP diagnosis and pathological diagnosis was greater than that between MsCT diagnosis and pathological diagnosis(0.870 vs.0.716).The accuracy rates of the two methods for diagnosis of stones with diameter longer than 1.0cm were higher than those shorter than 0.5cm(P<0.05).Conclusion Compared with MsCT,sensitivity and accuracy of MRCP are relatively higher for diagnosis of CBDs,whose consistency with diagnosis results of ERCP"golden standard"is better.Its clinical application value is higher.And the two methods are of higher detection accuracy rates for stones with diameter longer than 1.0cm.