摘要
目的 探讨螺旋CT胆道造影术 (SCTC)在疑诊为阻塞性黄疸患者中的应用价值和限度。方法 5 9例临床疑诊为阻塞性黄疸患者行螺旋CT检查 ,有 2 9例因血清总胆红素 (T Bil) >34μmol L ,估计其胆道难以显影而被排除 ;另 30例用 5 0 %胆影葡胺作为静脉胆道对比剂 ,进行SCTC。采用横断面图像、多平面重建和容积重建 3种方法 ,分析胆管树显影分级 (1～ 5级 )、总分级 (以同例 3种方法中最高级为准 )与胆管阻塞程度和水平、T Bil、直接胆红素 (D Bil)、丙氨酸转氨酶 (ALT)的关系以及图像质量。结果 胆管树分级在横断面图像、多平面重建和容积重建 3种方法间的差异均无显著性 (P >0 .0 5 ) ,4级和 5级之和分别占 86 .7% (2 6例 )、73.3% (2 2例 )和 86 .7% (2 6例 ) ;总分级与D Bil、ALT、阻塞程度有相关性 (rs=- 0 .719,- 0 .5 4 4 ,0 .6 5 0 ) ,而与T Bil和阻塞水平无相关性 (rs =- 0 .2 5 3,0 .2 6 1) ;图像质量在横断面图像与多平面重建之间差异有显著性 (P =0 .0 34) ,图像质量很好者在横断面图像、多平面重建和容积重建中分别占 93.3% (2 8例 )、6 6 .7% (2 0例 )和 70 .0 % (2 1例 )。结论 SCTC在经选择的疑诊为阻塞性黄疸的患者中具有一定的应用价值。
Objective To study spiral CT cholangiography (SCTC) before treatment in patients with obstructive jaundice due to unknown cause. Methods Between October 1998 and November 2000, a total of 59 patients with obstructive jaundice of unknown cause were examined by two phase enhanced spiral CT (eSCT). Twenty nine of these cases were excluded because they had had T Bil of >34 μmol/L so that their biliary duct system could not have been visualized. The remaining 30 patients were 17 male and 13 female with an age range of 31 76 years (mean 56.6). Pathologically, the lesion was proven to be carcinoma of pancreatic head ( n =9), Vater′s ampulla carcinoma ( n =4), extrahepatic or hilar cholangiocarcinoma ( n =13), hepatocellular carcinoma ( n =1), chronic pancreatitis ( n =1) and cholelithiasis ( n =2). SCTC was performed through intravenous injection of 20 ml 50% Cholografin within 20 min before eSCT. SCTC was undertaken with parameters of a slice thickness of 2 3 mm, a table feed of 3 5 mm, a gantry time of 0.75 sec, a reconstruction interval of 1 2 mm, a pitch of 1.1 1.2, a voltage of 120 kV, a current of 220 240 mA, a matrix of 512×512 and a scan range from the level above hepatic hilum to the third segment of duodenum within 60 105 min following the injection. Both reconstructed SCTC source images and later eSCT scans were considered as axial CT (ACT). Multiplanar reconstruction (MPR) was obtained immediately on the operator console. 3D imaging adopted in our study was volume rendering technology (VRT) that was processed on the Siemens 3D Virtuoso workstation within 30 min. Opacification of biliary tree (OBT) analyzed by Grades 1 to 5 and image quality (IQ) assessed by 4 scales as excellent, good, fair and poor were investigated in ACT, MPR and VRT, respectively. The correlation between total OBT, which was the highest among the 3 image methods in the same case, and T Bil, D Bil, ALT, severity of the biliary obstruction (SBO) as well as level of the obstruction was analyzed. Results In OBT, no statistically significant difference was found in the five grades by the three imaging techniques ( P >0.05), the distribution of percentages being 0, 0, 13.3%, 30.0% and 56.7% in ACT, 0, 6.7%, 20.0%, 30.0% and 43.3% in MPR and 0, 0, 13.3%, 40.0% and 46.7% in VRT. The evident correlation between total OBT and D Bil ( r s = -0.719 ), ALT ( r s =-0.544) and SBO ( r s =0.650) was showed. In IQ, only a statistical significance existed between ACT and MPR ( P =0.034), having the scales 'excellent to poor' in percentages of 93.3%, 6.7%, 0 and 0 for ACT, 66.7%, 30.0%, 3.3% and 0 for MPR and 70.0%, 23.3%, 6.7% and 0 for VRT, respectively. Conclusion According to our study, spiral CT cholangiography is very useful for the evaluation of selected patients with suspected obstructive jaundice before treatment. [
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2003年第3期268-271,共4页
Chinese Journal of Oncology
基金
"九五"国家科技重点攻关项目 ( 96 92 0 0 6 0 5 4)
关键词
螺旋CT胆道造影术
阻塞性黄疸
胆道肿瘤
胰腺肿瘤
胆管树
Biliary tract neoplasms
Panereatic neoplasms
Choleeystography
Tomo graphy, X ray computed
Obstructive jaundice
