良恶性胆道梗阻的CT、MRI诊断(附65例病例分析)简

目的对65例良、恶性胆道梗阻患者的CT、MRI影像资料进行分析，探讨CT、MRI成像各自在良、恶性胆道梗阻诊断方面的优缺点，提高对良、恶性胆道梗阻的诊断率。方法收集65例临床诊断为梗阻性黄疸的病人，行上腹部CT检查，同时行MRI、MRCP检查，所有病例均经手术及病理确诊。对其影像学征象进行统计分析，分别计算出各征象对胆道梗阻诊断的敏感性、特异性及准确性。结果以病理结果为标准，各征象的诊断敏感性、特异性及准确性如下：在CT上，结石的敏感性91．3％、特异性100％、准确性96．9％；管壁毛糙的敏感性90．6％、特异性100％、准确性95．4％；胆管壁不均匀增厚的敏感性82．8％、特异性100％、准确性93．8％；管壁强化的敏感性94．7％、特异性100％、准确性96．9％；实质性肿瘤及肿大淋巴结的敏感性100％、特异性97．5％、准确性98．5％；胆管扩张的敏感性100％、特异性100％、准确性98．5％；杯口征的敏感性87．0％、特异性100％、准确性95．4％；乌嘴征的敏感性92．6％、特异性100％、准确性96．9％；双管征的敏感性、特异性、准确性均为100％；在MRI上，结石的敏感性82．6％、特异性100％、准确性93．8％；管壁毛糙的敏感性84．4％、特异性100％、准确性92．3％：胆管壁不均匀增厚的敏感性65．5％、特异性100％、准确性84．6％；管壁强化的敏感性97．4％、特异性100％、准确性98．5％；实质性肿瘤及肿大淋巴结的敏感性、特异性、准确性均为100％；胆管扩张的敏感性、特异性、准确性均为100％；杯口征的敏感性95．7％、特异性100％、准确性98．5％；鸟嘴征的敏感性、特异性、准确性均为100％；双管征的敏感性、特异性、准确性均为100％；结论CT、MRI在显示胆道梗阻的直接、间接征象方面各有优缺点，两种检查方法相结合有助于明确良、恶性胆道梗阻诊断。

The Evaluation Value of CT and MRI in the Diagnosis of Benign and Malignant Biliary Obstruction, 65 Cases Reports Affiliated

Objective Analyzed the CT and MRI image data of 65 cases of biliary obstruction patients, to approach the advantages and disadvantages of CT and MP, I in the diagnosis of benign and malignant biliary obstruction, in order to improve the accurately diagnostic rate. Methods A total of 65 cases of biliary obstruction patients who were diagnosed by clinical went on plain and enhanced CT , MRI scan, and the image date were collected. The signs of CT and MRI were compared with each other and with operative pathological findings. The sensitivity, specificity and accuracy of each signs were calculated. Result With the pathological findings as gold standard, for each sign in diagnosis ofbiliary obstruction, the sensitivity, specificity and accuracy were as follows. For CT, the biliary calculi with a sensitivity of 91.3%, specificity of 100%, accuracy of 96.9%; crude tube wall with a sensitivity of 90.6%, specificity of 100%, accuracy of 95.4%; bile duct wall irregular thickening with a sensitivity of 82.8%, specificity of 100%, accuracy of 93.8%; the wall enhancement with a sensitivity of 94.7%, specificity of 100%, accuracy of 96.9%; the solid tumor and lymph nodes with a sensitivity of 100%,specificity of 97.5%, accuracy of 98.5%;The bile duct dilatation with a sensitivity of 100%, specificity of 100%, accuracy of 98.5%;the cup sign with a sensitivity of 87.0%, specificity of 100%, accuracy of 95.4%; the angle sign with a sensitivity of 92.6%, specificity of 100%, accuracy of 96.9%; the sensitivity, specificity, accuracy of double-duct sign in all 100%. For MRI, the biliary calculi with a sensitivity of 82.6%, specificity of 100%, accuracy of 93.8%; crude tube wall with a sensitivity of 84.4%, specificity of 100%, accuracy of 92.3%; bile duct wall irregular thickening with a sensitivity of 65.5%, specificity of 100%, accuracy of 84.6%; the wall enhancement with a sensitivity of 97.4%, specificity of 100%, accuracy of 98.5%; the sensitivity, specificity, accuracy of solid tumor and lymph nodes in all 100%; the sensitivity, specificity, accuracy of bile duct dilatation in all 100%; the cup sign with a sensitivity of 95.7%, specificity of 100%, accuracy of 98.5%; the sensitivity, specificity, accuracy of angle sign in all 100%; the sensitivity, specificity, accuracy of double-duct sign in all 100%. Conclusion For the demonstration of biliary obstruction, CT and MRI had each advantages and disadvantages, combined each could be help to distinguish the benign and malignant biliary obstruction.