“黑环征”联合胰胆管形态改变对恶性低位胆道梗阻性疾病诊断的鉴别价值  

Differential Diagnosis Value of “black ring sign” Combined with Pancreaticobiliary Duct Morphological Changes of Malignant Low-Lever Biliary Obstructive Diseases

作　　者：杨秀娟[1] 罗江平[2] 曾文兵[1] YANG Xiujuan;LUO Jiangping;ZENG Wenbing(Department of Radiology,Chongqing Three Gorges Central Hospital,Wanzhou,Chongqing 404000,P.R.China)

机构地区：[1]重庆三峡中心医院放射科,万州404000 [2]重庆三峡中心医院介入科,万州404000

出　　处：《临床放射学杂志》2019年第10期1872-1876,共5页Journal of Clinical Radiology

摘　　要：目的探讨"黑环征"联合胰胆管形态改变对恶性低位胆道梗阻性疾病诊断的鉴别价值。方法病理证实恶性低位胆道梗阻67例,行常规MRI、MRCP扫描。观察肿瘤是否出现"黑环征"及胰胆管形态学改变。结果胰头癌可见"黑环征",胆总管下段癌、壶腹癌未见。三组间胆道梗阻水平、管征差异存在显著统计学意义(P<0.01)。胰头癌为胆总管胰腺段梗阻,常见分离型双管征;胆总管下段癌、壶腹癌为胆总管壁内段梗阻,常见平行或聚拢型双管征。仅胆总管下段癌见"三管征",胰头癌见"四管征"。三组间胆道梗阻面管腔形态差异存在统计学意义(P<0.05),胰头癌、胆总管下段癌常见截断型,壶腹癌为漏斗或鸟嘴型。三组间肝内胆管扩张形态无统计学差异。胰胆管形态改变诊断胰头癌的ROC曲线下面积、敏感性、特异性分别为0.864、85.7%、87.2%。"黑环征"诊断胰头癌的ROC曲线下面积、敏感性、特异性分别为0.714、42.9%、100%。"黑环征"与胰胆管形态改变诊断胰头癌的ROC曲线下面积、敏感性、特异性分别为0.882、89.3%、87.2%。结论 "黑环征"联合胰胆管形态改变对恶性低位胆道梗阻性疾病鉴别诊断具有重要价值。Objective To explore the value of "black ring sign" combined with pancreaticobiliary duct morphological changes in the differential diagnosis of malignant low-level biliary obstructive diseases. Methods 67 patients with malignant low-level biliary obstruction were enrolled. Conventional MRI、MRCP scanning were performed. Observe whether the tumor has a "black ring sign" and morphological changes of pancreaticobiliary duct. Results Pancreatic head carcinoma showed "black ring sign", while the distal common bile duct carcinomas and ampullary carcinomas did not. There were statistically significant differences(P<0.01)among groups in the obstructive level and duct sign. Pancreatic head carcinoma with obstructive level located in the pancreatic segment of the common bile duct usually showed separate double-duct sign. Distal common bile duct carcinoma and ampullary carcinoma with obstructive level located in the intramural division of the common bile duct usually showed parallel or converging double-duct sign. Only distal common bile duct carcinoma showed three-segment sign and the pancreatic head carcinoma showed four-segment sign. There were statistical differences(P<0.05)among groups in the shapes of the distal margin of dilated pancreaticobiliary duct. Pancreatic head carcinoma and distal common bile duct carcinoma showed mostly blunted form, ampullary carcinoma showed funnel or beak form. There was no statistical difference in the morphological change of the dilated intrahepatic bile duct among the groups. The area under the ROC curve,sensitivity and specificity of pancreaticobiliary duct morphological changes in the diagnosis of pancreatic head carcinoma were 0.864,85.7%、and 87.2%,respectively,those of "black ring sign" were 0.714,42.9% and 100%,those of "black ring sign" and pancreaticobiliary duct morphological changes were 0.882,89.3% and 87.2%. Conclusion "black ring sign" combined with pancreaticobiliary duct morphological changes is of great value in the differential diagnosis of malignant low-level bili

关 键 词：低位胆道梗阻 黑环征 胰胆管形态改变 

分 类 号：R65[医药卫生—外科学]