CAJ | 학술논문

目的利用体外超声胆管造影模型,探讨不同深度下、不同浓度造影剂对造影剂衰减时间的影响及造影剂信号强度对小结石显示的影响.方法以内径0.5 cm的硅胶管模拟胆总管,在不同深度下(5、10和15 cm)分别用不同浓度(1/200、1/300、1/400、1/600标准浓度)SonoVue造影剂进行管道内造影,观察造影剂信号衰减情况;取内径1.0cm的硅胶管模拟扩张胆总管,以小石粒放入模拟胆总管结石,观察不同直径结石的超声胆管造影表现.结果常用造影剂标准浓度的1/200,深度为5、10、15cm时,后壁清晰显示时间分别为54、47、20.5 s;出现表面线状高亮回声出现时间分别为615、380、1140s;出现表面线状高回声后,注入生理盐水管腔依然能够显影,持续时间分别为150、260、285 s.当浓度低于标准浓度的1/200时,在3种深度下后壁均能清晰显示,但持续时间降低.在保留有胆汁的胶管里,造影剂注入后,造影剂与胆汁之间有明显的界线;当胆汁浓稠时,造影剂无法通过胆汁.当造影剂浓度为标准浓度的1/400时,内径为0.5～1.0 cm的小结石在造影模式下清晰显示为充盈缺损,后方伴声衰减;当造影剂浓度高于标准浓度的1/400时,结石显示不清楚或被淹没.在直径为0.3 cm或以下的结石,3种浓度的造影剂均不能显示明确的"充盈缺损"征.结论腔内造影能获得较长的造影持续时间,且可以进行重复造影.1/300标准浓度的造影剂浓度能够获得合适的增强强度,而结石造影则宜选用1/400标准浓度的造影剂.胆汁对造影剂有负面影响,造影前应尽量抽尽胆汁.超声胆管造影不能提高超声对直径小于0.3 cm的结石的发现率.
목적 이용체외초성담관조영모형,탐토불동심도하、불동농도조영제대조영제쇠감시간적영향급조영제신호강도대소결석현시적영향.방법 이내경0.5 cm적규효관모의담총관,재불동심도하(5、10화15 cm)분별용불동농도(1/200、1/300、1/400、1/600표준농도)SonoVue조영제진행관도내조영,관찰조영제신호쇠감정황;취내경1.0cm적규효관모의확장담총관,이소석립방입모의담총관결석,관찰불동직경결석적초성담관조영표현.결과 상용조영제표준농도적1/200,심도위5、10、15cm시,후벽청석현시시간분별위54、47、20.5 s;출현표면선상고량회성출현시간분별위615、380、1140s;출현표면선상고회성후,주입생리염수관강의연능구현영,지속시간분별위150、260、285 s.당농도저우표준농도적1/200시,재3충심도하후벽균능청석현시,단지속시간강저.재보류유담즙적효관리,조영제주입후,조영제여담즙지간유명현적계선;당담즙농주시,조영제무법통과담즙.당조영제농도위표준농도적1/400시,내경위0.5～1.0 cm적소결석재조영모식하청석현시위충영결손,후방반성쇠감;당조영제농도고우표준농도적1/400시,결석현시불청초혹피엄몰.재직경위0.3 cm혹이하적결석,3충농도적조영제균불능현시명학적"충영결손"정.결론 강내조영능획득교장적조영지속시간,차가이진행중복조영.1/300표준농도적조영제농도능구획득합괄적증강강도,이결석조영칙의선용1/400표준농도적조영제.담즙대조영제유부면영향,조영전응진량추진담즙.초성담관조영불능제고초성대직경소우0.3 cm적결석적발현솔.
Objective To evaluate the duration of contrast enhancement by varying the concentrations of contrast agent and depth,and to characterize small common bile duct(CBD)stones under different concentrations of contrast agent,using an ultrasonic cholangiongraphy model.Methods The attenuation of contrast agent(Sono Vue)at various concentrations(1/200,1/300,1/400 and 1/600 of standard) was studied in cholangiography of a silicon tube(0.5 cm by inner diameter)as simulated CBD that was placed at different depth(5 cm,10 cm and 15 cm beneath the surface,respectively).Thereafter,the ultrasonography of simulated CBD stones in various sizes placed in a silicon tube(1.0 cm by inner diameter)as simulated dilated CBD was examined.Results Given 1/200 standard concentration of SonoVue at variable depths(5 cm,10 cm and 15 cm,respectively),the rear wall of tube remained clearly visible for 54S,47 S and 20.5 s,and then showed an echogenic line at 615 s,380 s and 1140 S, respectively.After emergence of the inner surface echogenic line,an injection of normal saline was able to maintain the clear visualization for 150 s,260 s and 285 s,respectively.Given the concentration of Sono Vue below 1/200, the rear wall Can be clearly visualized at a11 three different depths.albeit for a shorter duration.In a bilecontaining tube,there was a clear borderline between Sono Vue suspension and bile.Thicker bile was seen to prevent passage of the contrast agent. Given 1/400 standard concentration of Sono Vue, stones with diameter of 0.5-1.0 cm were clearly visualized as filling defects with posterior acoustic shadowing. Given the Sono Vue concentration over 1/400 of standard, the stones were submerged or poorly visualized. For stones less than 0.3cm in size, Sono Vue with any of above concentrations (1/200, 1/300 and 1/400 of standard) failed to show clear signs of filling defects. Conclusions Intra-luminal enhanced ultrasonography can be useful for longer duration of visualization and repeated attempts. Proper enhancement is achieved with 1/300 standard Sono Vue concentration. When used for stones, the optimal concentration of SonoVue may be 1/400 of standard. Bile may compromise the effect of contrast agent and therefore should be well cleared before cholangiography. Ultrasonic cholangiography is not found to improve the detection rate of small CBD stones less than 0. 3 cm in size.