摘要
目的探讨磁共振胰胆管成像(MRCP)对肝外胆管结石患者诊断准确度的影响。方法抽取西山煤电(集团)有限责任公司职工总医院2018年12月至2021年3月收治的疑似肝外胆管结石患者57例,均行MRCP检查及CT检查。统计MRCP及腹部CT检查结果;比较MRCP及腹部CT检查诊断效能,包括诊断准确度、灵敏度、特异度、漏诊率、误诊率;比较MRCP、腹部CT检查对不同直径结石的检出情况,以及MRCP、腹部CT检查肝外胆管结石的影像学分析。结果以超声内镜检查结果为金标准,57例疑似肝外胆管结石患者共检出阳性34例,阴性23例;MRCP检查检出阳性34例,阴性23例;腹部CT检查检出阳性29例,阴性28例。MRCP诊断肝外胆管结石的准确度、灵敏度均高于腹部CT检查,漏诊率低于腹部CT检查(P<0.05)。MRCP检查长径<9 mm的肝外胆管结石检出率(90.48%,19/21)高于腹部CT检查(52.38%,11/21),P<0.05。腹部CT检查:胆总管表现为高密度影,其中无明显强化或轻度强化28例,增厚环形强化29例;误诊的3例患者中2例为肝内结石,1例无结石;漏诊的8例患者均为泥沙样结石,结石长径仅1例为9 mm,其余均<5 mm。MRCP检查:胆总管内表现为充盈缺损,远端表现为杯口状,胆汁周围环绕高信号,较小结石表现为条状或点状;1例漏诊患者为泥沙样结石,直径<5 mm;1例误诊患者为肝内胆管结石。结论MRCP检查应用于肝外胆管结石患者,可明显提高诊断准确度、灵敏度、特异度,降低漏诊率,可为临床提供详细信息,对手术方案制定有指导作用。
Objective To investigate the effect of magnetic resonance cholangiopancreatography(MRCP)on the diagnostic accuracy of patients with extrahepatic bile duct stones.Methods Fifty-seven patients with suspected extrahepatic bile duct stones treated in Staff General Hospital of Xishan Coal and Electricity(Group)Co.,Ltd.from December 2018 to March 2021 were selected,and all of them underwent MRCP examination and CT examination.The results of MRCP and abdominal CT were counted;and the diagnostic efficacy of MRCP and abdominal CT were compared,including diagnostic accuracy,sensitivity,specificity,missed diagnosis rate and misdiagnosis rate.The detection results of stones with different diameters by MRCP and abdominal CT were compared,and the imaging analysis of extrahepatic bile duct stones by MRCP and abdominal CT were compared.Results Taking the results of endoscopic ultrasonography as the gold standard,34 cases were positive and 23 cases were negative in 57 patients with suspected extrahepatic bile duct stones;MRCP detected out 34 positive patients and 23 negative patients;abdominal CT examination showed 29 positive patients and 28 negative patients.The accuracy and sensitivity of MRCP in diagnosing extrahepatic bile duct stones were higher than those of abdominal CT examination,and the missed diagnosis rate was lower than that of abdominal CT examination(P<0.05).The detection rate of extrahepatic bile duct stones with major diameter less than 9 mm by MRCP(90.48%,19/21)was higher than that by abdominal CT(52.38%,11/21),P<0.05.Abdominal CT examination showed that the common bile duct had high-density shadows,of which 28 cases had no obvious enhancement or mild enhancement,29 cases had thickened ring enhancement.Three patients were misdiagnosed,of which 2 cases had intrahepatic stones and 1 had no stones.Eight patients who had missed diagnosis all had silt like stones,of them only 1 case had stones with a maximum diameter of 9 mm,and the rest had stones with diameter less than 5 mm.MRCP examination showed that the common bile duct had a filling defect,the distal end had a cup-like mouth,the bile was surrounded by high signals,and the smaller stones had strips or spots;1 patients with missed diagnosis had a silt-like stone with a diameter of less than 5 mm;1 case was misdiagnosed as intrahepatic bile duct stones.Conclusions The application of MRCP in patients with extrahepatic bile duct stones can significantly improve the diagnostic accuracy,sensitivity,and specificity,reduce the missed diagnosis rate,provide detailed information,and guide the formulation of surgical plans.
作者
张文莉
Zhang Wenli(MRI Room,Staff General Hospital of Xishan Coal and Electricity(Group)Co.,Ltd.,Taiyuan 030053,China)
出处
《中国实用医刊》
2022年第3期80-83,共4页
Chinese Journal of Practical Medicine
关键词
磁共振胰胆管成像
腹部CT检查
肝外胆管结石
诊断效能
影像学分析
Cholangiopancreatography,magnetic resonance
Abdominal computed tomography examination
Extrahepatic bile duct stones
Diagnostic power
Imaging analysis
