胆道疾病的影像检查(附486例报告)

目的 评价各种影像检查方法在胆道疾病诊断中的价值。方法 回顾性复习486例经手术病理证实的胆道疾病影像资料,分析各检查方法的优势和局限性。结果 26例胆囊内阴性结石在传统造影中显示清楚。胆道直接造影能清楚显示胆道解剖形态及病因。B超和CT对胆道结石诊断阳性准确率为91.3%和90.3%,13例泥沙样胆石CT漏诊。超声诊断慢性胆囊炎和胆囊息肉符合率达100％和93.3%。MRCP的“胆管树”有助于肝门胆管癌的确诊。结论 传统造影法能较好显示胆囊阴性结石,胆道直接造影为定性诊断提供重要依据。B超和CT显示胆道结石优于其他方法。超声是慢性胆囊炎和息肉样病变最好检查方法。MRCP是诊断重度胆道梗阻的理想影像手段。

Imaging diagnosis of biliary tract lesions (with a report of 486 cases)

Objective To evaluate the various imaging modalities in the diagnosis of biliary tract lesions. Methods The imaging findings of 486 cases of biliary tract lesions proved surgically and pathologically were retrospectively reviewed. The advantage and the limitation of each examination were analyzed. Results Twenty six cases with negative stone in gallbladder were demonstrated in conventional cholecystography. The anatomical morphology and the pathogensis were well shown on direct cholangiography. The positive accuracy of ultrasonography (US) and CT for biliary duct calculus was 91. 3% and 90. 3%, respectively. Sanded stone were missed on CT in 13 cases. The consistent rate of US diagnosis of chronic cholecystitis and gallbladder polyps was 100% and 93. 3%, respectively. The "bile duct tree" at MRCP helped the diagnosis of the cholangiocarcinoma arising at the portal hepatis. Conclusion The negative stone in gallbladder can be demonstrated by conventional cholecystography. Direct cholangiography can provide important evidence for the qualitative diagnosis. US and CT are superior to other modalities in detecting biliary duct calculus. US is the best imaging modality for chronic cholecystitis and polypoid lesion of gallbladder. 3D MRCP is an ideal imaging for severe bile duct obstruction.