64层螺旋CT胆道三维成像对肝胆管结石病的诊断价值  

Clinical application of three-dimensional imaging of 64-slices spiral CT choIangiography in pathological diagnosis of hepatolithiasis

作　　者：范应方[1] 方驰华[1] 朱新勇[1] 项楠[1] 杨剑[1] 贾洪顺[2] 全显跃[2] 

机构地区：[1]南方医科大学附属珠江医院肝胆外科,广州510282 [2]南方医科大学附属珠江医院影像中心,广州510282

出　　处：《中华消化外科杂志》2007年第6期428-432,共5页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金（30470493）;广东省科技计划项目（2003C34303）;广东省自然科学基金研究团队项目（6200171）;国家高技术研究发展计划（863计划）（2006AA02 Z00346）

摘　　要：目的探讨64层螺旋CT胆道三维重建技术对胆管结石疾病的诊断价值和对手术的指导意义。方法对65例肝胆管结石疾病患者，利用64层螺旋CT平扫、双期增强扫描以及最大密度成像、曲面重建、最小密度成像等方法行胆道三维重建，进行结石病的定位、定性及诊断，并与手术及病理结果进行比较。结果60例患者获得清晰的胆道三维重建图像，可以良好显示结石部位和形态，肝内外胆管扩张的程度和形态，以及肝脏组织有无萎缩和代偿性肥大等病变。重建胆管与周围组织解剖图像清晰，能准确确定梗阻部位以及梗阻的原因，区别肿瘤、结石或炎症。与手术结果比较，64层螺旋CT胆道三维成像对Ⅰ型、Ⅱ型、E型、胆总管型结石诊断符合率分别77．8％、80％、100％、100％。结论64层螺旋CT胆道三维成像是一种安全、敏感、无创性胆管疾病检查技术，能清晰显示胆管与周围组织的三维解剖关系。结合平扫、增强扫描，对肝胆管结石病及其他胆道疾病的诊断有极高的临床应用价值。Objective To investigate the value of three-dimensional imaging of 04-slices spiral CT （ 04S- SCT） cholangiography in pathological diagnosis and operation of hepatolithiasis. Methods After the plain scan and double phase enhanced scan of 64S-SCT, the three-dimensional imaging of cholangiography of 65 patients with hepatolithiasis was established by maximum intensity projection （ MIP）, minimum intensity projection （MinlP） and curved planar reformation （CPR） to locate, classify and qualitatively diagnose hepatolithiasis, and to be compared with the outcome of operation. Results Cholangiography of 64S-SCT was performed successfully on 60 pa- tients. Three-dimensional imaging clearly displayed the foci and morphous of calculi, morphous and degree of in- tra- and extra-hepatic ductal dilation, atrophy and compensatory hypertrophy of hepatic tissue. It accurately located the obstruction of biliary duct and distinguished calculi foci, tumor and inflammation of biliary-pancreas duct. The accuracy rate of diagnosis with three-dimensional imaging of 64S-SCT cholangiography for type Ⅰ ,Ⅱ , E and common biliary duct type hepatolithiasis was 77.8%, 80%, 100% and 100% , respectively. Conclusions Three-dimensional imaging of 64S-SCT cholangiography is an atraumatic, sensitive, safe approach in diagnosis of hepatolithiasis. It can clearly display the three-dimensional anatomic structures of biliary duct and adjacent organs and tissues. It plays an important role in diagnosing hepatolithiasis and other biliary diseases when combined with plain scan and enhanced scan.

关 键 词：64层螺旋CT 肝胆管结石病 三维成像 

分 类 号：R686[医药卫生—骨科学]