磁共振成像与彩色多普勒超声诊断胆道结石临床价值比较

doi:10.3969/j.issn.1672-5069.2020.05.036

摘要/Abstract

摘要： 目的比较磁共振成像(MRI)与彩色多普勒超声(CDUS)在诊断胆道结石方面的临床应用价值。方法 2016年11月～2018年11月我院诊治的136例患者,均接受MRI和CDUS检查,以内镜下逆行胰胆管造影术( ERCP)检查为“金标准”,比较MRI和CDUS检查的诊断效能。结果在136例患者中,经ERCP术后证实存在胆道结石115例,其中单发结石65例,多发结石50例,MRI的检出率分别为89.2%和100.0%,显著高于CDUS(分别为76.9%和56.0%,P<0.05);ERCP诊断大于1.0 cm、0.5～1.0 cm和<0.5 cm分别为49例、57例和9例,MRI的检出率分别为100.0%、91.2%和77.8%,显著高于CDUS的79.6%、63.2%和33.3%(P<0.05);MRI检查出胆囊、肝外胆管、肝内胆管和胆总管结石21例、30例、20例和37例,而CDUS只分别检出了18例(85.7%)、 18例(60.0%)、17例(65.4%)和25例(65.8%);本组MRI总体检出率为93.9%,显著高于CDUS的67.8%(P<0.05),MRI的误诊率为4.9%,而CDUS为10.3%。结论尽管MRI检查诊断胆道结石的总体效能高于CDUS检查,但MRI和CDUS临床应用的价值可能与结石的位置和大小密切相关,临床应根据实际工作需要灵活选择应用。

关键词: 胆道结石, 磁共振成像, 彩色多普勒超声, 诊断 , ,

Abstract: Objective The purpose of this study was to compare the clinical value of magnetic resonance imaging (MRI) and color Doppler ultrasound (CDUS) in the diagnosis of patients with cholangiolithiasis. Methods The clinical data of 136 patients were retrospectively analyzed in our hospital from November 2016 through November 2018. All patients underwent MRI and CDUS examination before endoscopic retrograde cholangiopancreatography (ERCP) was conducted. The detection rate and diagnostic efficacy of MRI and CDUS in different parts and different sizes of stones were compared to determine their clinical value. Results Out of the 136 patients, the ERCP showed that 115 patients had cholangiolithiasis, 65 patients with single and 50 with multiple stones, and for them, the detective rate of MRI were 89.2% and 100.0%, significantly higher than 76.9% and 56.0% (P<0.05) by CDUS; the ERCP demonstrated that the size of 1.0 cm, 0.5 to 1.0 cm and less than 0.5 cm of stones were in 49, 57 and 9 patients, and for them, the detective rate of MRI were 100.0%, 91.2% and 77.8%, significantly higher than 79.6%, 63.2% and 33.3%(P<0.05) by CDUS; the MRI detected stone from gall bladder, extrahepatic bile duct, intrahepatic bile duct and common bile duct in 21, 30, 20 and 37, while the CDUS examination only found in 18 (85.7%), 18 (60.0%), 17 (65.4%) and 25 (65.8%) patients; the total detective rate of stones in our series by MRI was93.9%, much higher than 67.8%(P<0.05) by CDUS, and the misdiagnosing rate by MRI was 4.9%, and that by CDUS was 10.3%. Conclusion Although the overall diagnostic efficacy of MRI for cholangiolithiasis is higher than that of CDUS, the clinical application of MRI and CDUS is closely related to the locations and sizes of stones, and the clinicians should select them appropriately to improve the diagnosis.

Key words: Cholangiolithiasis, Magnetic resonance imaging, Color Doppler ultrasound, Diagnosis

张杰, 张宁英, 马淑梅. 磁共振成像与彩色多普勒超声诊断胆道结石临床价值比较[J]. 实用肝脏病杂志, 2020, 23(5): 747-750.

Zhang Jie, Zhang Ningying, Ma Shumei.. Comparison of magnetic resonance imaging and colorDoppler ultrasound examination in diagnosis of patients with cholangiolithiasis[J]. Journal of Practical Hepatology, 2020, 23(5): 747-750.

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