CAJ | 학술논문

目的良恶性胆道狭窄在诊疗手段的制订及预后等方面的差异较大,本文旨在探讨对磁共振胆胰管造影(MRCP)和CT动态增强扫描(DCE-CT)图像行量化分析,评估其诊断良恶性胆道狭窄的价值.资料与方法回顾性分析27例良性胆道狭窄(良性组)和30例恶性胆道狭窄(恶性组)患者的MRCP和DCE-CT资料,比较两组狭窄段胆管壁厚、长度、管径,狭窄段上方胆管扩张程度以及狭窄段管壁强化程度,并分析其与胆管狭窄性质的相关性,评估MRCP和DCE-CT预测胆道狭窄良恶性的诊断效能.结果恶性组狭窄段壁厚、长度及上方扩张段最末端胆管管径大于良性组[(3.2±2.0)mm对(2.1±0.6)mm、(15.8±8.1)mm对(9.5±6.5)mm、(12.7±3.6)mm对(9.3±2.7)mm](t=2.825、3.270、4.025,P<0.001),狭窄段胆管管径明显小于良性组[0 mm对(2.0±0.9)mm](Z=-3.909,P<0.001).胆管狭窄性质与狭窄段胆管壁厚、门静脉期-平扫和延迟期-平扫狭窄段管壁CT差值呈正相关,与狭窄段胆管管径呈负相关(t=-6.424~2.309,P<0.05).狭窄段壁厚、管径、门静脉期-平扫管壁CT差值及延迟期-平扫管壁CT差值是恶性胆道狭窄的重要预测因子(F=41.090,P<0.001).MRCP和DCE-CT诊断57例胆道狭窄患者的灵敏度、特异度、符合率及约登指数分别为96.67%、100.00%、98.25%、0.97,对胆道狭窄良恶性的预测差异有统计学意义(AUC=0.994,P<0.001).结论采用MRCP结合DCE-CT对良、恶性胆道狭窄进行量化分析,能更准确地诊断良恶性胆道狭窄,狭窄段胆管壁厚、管径、门静脉期-平扫管壁CT差值及延迟期-平扫管壁CT差值具有鉴别诊断价值.
목적 량악성담도협착재진료수단적제정급예후등방면적차이교대,본문지재탐토대자공진담이관조영(MRCP)화CT동태증강소묘(DCE-CT)도상행양화분석,평고기진단량악성담도협착적개치.자료여방법 회고성분석27례량성담도협착(량성조)화30례악성담도협착(악성조)환자적MRCP화DCE-CT자료,비교량조협착단담관벽후、장도、관경,협착단상방담관확장정도이급협착단관벽강화정도,병분석기여담관협착성질적상관성,평고MRCP화DCE-CT예측담도협착량악성적진단효능.결과 악성조협착단벽후、장도급상방확장단최말단담관관경대우량성조[(3.2±2.0)mm대(2.1±0.6)mm、(15.8±8.1)mm대(9.5±6.5)mm、(12.7±3.6)mm대(9.3±2.7)mm](t=2.825、3.270、4.025,P<0.001),협착단담관관경명현소우량성조[0 mm대(2.0±0.9)mm](Z=-3.909,P<0.001).담관협착성질여협착단담관벽후、문정맥기-평소화연지기-평소협착단관벽CT차치정정상관,여협착단담관관경정부상관(t=-6.424~2.309,P<0.05).협착단벽후、관경、문정맥기-평소관벽CT차치급연지기-평소관벽CT차치시악성담도협착적중요예측인자(F=41.090,P<0.001).MRCP화DCE-CT진단57례담도협착환자적령민도、특이도、부합솔급약등지수분별위96.67%、100.00%、98.25%、0.97,대담도협착량악성적예측차이유통계학의의(AUC=0.994,P<0.001).결론 채용MRCP결합DCE-CT대량、악성담도협착진행양화분석,능경준학지진단량악성담도협착,협착단담관벽후、관경、문정맥기-평소관벽CT차치급연지기-평소관벽CT차치구유감별진단개치.
Purpose The diagnosis, treatment and prognosis of benign and malignant biliary stricture are significantly different. This study aims to evaluate the quantitative analysis of biliary structures using magnetic resonance cholangiopancreatography (MRCP) combined with dynamic contrast enhanced CT (DCE-CT).Materials and Methods The quantitative parameters of MRCP and DCE-CT imaging data from 27 patients with benign biliary stricture (benign group) and 30 patients with malignant biliary stricture (malignant group) were retrospectively analyzed. The wall thickness, stricture length and diameter, proximal ductal dilatation and degree of enhancement in two groups were compared, and its correlation was analyzed to evaluate the accuracy of MRCP and DCE-CT.Results There were significant differences in wall thickness [(3.2±2.0) mmvs (2.1±0.6) mm], stricture length [(15.8±8.1) mmvs (9.5±6.5) mm] and diameter [0 mmvs (2.0±0.9) mm], proximal ductal dilatation and the degree of enhancement [(12.7±3.6) mmvs (9.3±2.7) mm] between the two groups (t=2.825, 3.270, 4.025,P<0.001;Z=-3.909,P<0.001). Multivariable stepwise regression analysis showed that the wall thickness and diameter, and the CT HU in portal venous and equilibrium phases combined with CT plain scanning were significant predictors of malignant biliary strictures (t=-6.424-2.309,P<0.05). The sensitivity, specificity, inter-modality agreement and Youden index of MRCP and DCE-CT in diagnosing 57 patients with biliary stricture were 96.67%, 100.00%, 98.25% and 0.97, respectively; with statistical significance in predicting benign and malignant biliary stricture (AUC=0.994,P<0.001).Conclusion Using MRCP and DCE-CT, the wall thickness and diameter of the stricture, and the difference in CT HU in portal venous and equilibrium phases combined with CT plain scanning are valuable in differential diagnosis of benign and malignant biliary stricture.