CT增强结合多b值DWI对胆总管炎性狭窄与肿瘤性病变所致狭窄的鉴别诊断研究  

Differential Diagnosis of Inflammatory Stenosis of Common Bile Duct and Stenosis Caused by Neoplastic Lesions by CT Enhancement Combined with Multi b-Value DWI

作　　者：刘搏 唐文博 曹晨 张天乐[4] 辛伟凡 刘军领[6] 刘贵林[7] LIU Bo;TANG Wen-bo;CAO Chen;ZHANG Tian-le;XIN Wei-fan;LIU Jun-ling;LIU Gui-lin(Department of Radiology,The First Medical Center of PLA General Hospital,Beijing,100873,China;Hepatobiliary Surgery,The First Medical Center of PLA General Hospital,Beijing,100873,China;Department of Radiology,Renqiu People’s Hospital,Cangzhou,Hebei,062550,China;CT/MRI Room,Affiliated Hospital of Hebei University,Baoding,Hebei,071000,China;Department of Radiology,Hebei Sixth People’s Hospital,Baoding,Hebei,071000,China;Department of Radiotherapy,The Second Hospital of Hebei Medical University,Shijiazhuang,Hebei,050000,China;Department of Radiology,Qinhuangdao Third Hospital of Hebei Province,Qinhuangdao,Hebei,066001,China)

机构地区：[1]中国人民解放军总医院第一医学中心放射诊断科,北京100873 [2]中国人民解放军总医院第一医学中心肝胆外科,北京100873 [3]任丘市人民医院放射诊断科,河北沧州062550 [4]河北大学附属医院CT/MRI室,河北保定071000 [5]河北省第六人民医院放射诊断科,河北保定071000 [6]河北医科大学第二医院放疗科,河北石家庄050000 [7]河北省秦皇岛市第三医院放射诊断科,河北秦皇岛066001

出　　处：《现代生物医学进展》2022年第13期2488-2494,共7页Progress in Modern Biomedicine

基　　金：北京市自然科学基金重点项目(7171008)。

摘　　要：目的:探讨计算机断层扫描(CT)增强结合多b值弥散加权成像(DWI)对胆总管炎性狭窄与肿瘤性病变所致狭窄的鉴别诊断价值。方法:回顾性分析2017年4月-2021年10月于我院经手术病理或逆行胰胆管造影(ERCP)证实为胆总管炎性或肿瘤性狭窄的106例患者的临床资料,术前均行CT增强、多b值(200、400、600、800、1000 s/mm~2)DWI的磁共振成像(MRI)检查并测量其多b值DWI下的ADC值,分析胆总管炎性狭窄与肿瘤性狭窄的影像表现,比较CT增强、多b值DWI单独及结合对胆总管炎性狭窄与肿瘤性狭窄的鉴别诊断效能。结果:106例患者中胆总管炎性狭窄共43例,肿瘤性狭窄患者共63例。当b值分别为200、400、600、800、1000 s/mm~2时,胆总管肿瘤性病变ADC值均显著低于胆总管炎性狭窄,差异均具统计学意义(P<0.05),随着b值增加,其ADC值均减小。当b值分别取200、400、600、800、1000 s/mm~2时,对应曲线下面积(AUC)分别为0.574、0.705、0.715、0.781、0.726,b值为800 s/mm~2时诊断胆总管炎性狭窄与肿瘤性狭窄的效能最佳。CT增强结合多b值DWI对比CT增强或多b值DWI对胆总管炎性狭窄与肿瘤性狭窄的诊断效能最佳。结论:当多b值DWI取800 s/mm~2时,CT增强结合多b值DWI可以显著提高胆总管炎性狭窄与肿瘤性狭窄的鉴别诊断价值,具有一定的临床应用价值。Objective:To investigate the value of computed tomography(CT) enhancement combined with multi b-value diffusion-weighted imaging(DWI) in the differential diagnosis of common bile duct inflammatory stenosis and stenosis caused by tumor lesions.Methods:The clinical data of 106 patients with choledocholitis or neoplastic stenosis confirmed by surgical pathology or retrograde cholangiopancreatography(ERCP) in our hospital from April 2017 to October 2021 were retrospectively analyzed.CT enhancement,multi b-value(200,400,600,800,1000 s/mm^(2)) DWI were performed before surgery,and ADC values under multi-b-value DWI were measured to analyze the imaging manifestations of inflammatory common bile duct stenosis and neoplastic stenosis.To compare the differential diagnosis of choledocholitis stricture and neoplastic stricture by CT enhancement and multi-b-value DWI alone and in combination.Results:There were 43 cases of choledochal inflammatory stenosis and 63 cases of neoplastic stenosis among 106patients.When b values were 200,400,600,800,and 1000 s/mm^(2),the ADC values of common bile duct neoplastic lesions were significantly lower than those of common bile duct inflammatory stenosis,with statistical significance(P<0.05).With the increase of b values,the ADC values decreased.When b value was 200,400,600,800,and 1000 s/mm^(2),the corresponding area under the curve(AUC) were 0.574,0.705,0.715,0.781,and 0.726 respectively.When b value was 800 s/mm^(2),the diagnostic efficiency of inflammatory bile duct stenosis and neoplastic stenosis was the best.CT enhancement combined with multi-b-value DWI has the best diagnostic efficacy for choledocholitis stricture and neoplastic stricture.Conclusion:When multi-b-value DWI is 800 s/mm^(2),CT enhancement combined with multi-b-value DWI can significantly improve the differential diagnosis value of choledochal inflammatory stenosis and neoplastic stenosis,which has certain clinical application value.

关 键 词：CT增强 多b值DWI 胆总管 炎性狭窄 肿瘤性狭窄 鉴别诊断 

分 类 号：R657.4[医药卫生—外科学] R735.8[医药卫生—临床医学] R445