中国中西医结合影像学杂志

目的：探讨低张CT胆道成像MinIP联合CPR对胆道梗阻的诊断价值。方法：前瞻性选择210例临床疑诊胆道梗阻并行CT胆道成像的患者为研究对象，按随机数表法分为常规组（A组）和低张组（B1组、B2组），3组各70例。A组于正常张力下行CT胆道扫描，图像行MPR。B1组、B2组采用低张分时段分次饮水法充盈十二指肠后扫描，B1组图像行MPR,B2组行MinIP+CPR。分析图像，并对胆道梗阻进行定位、定性诊断，比较3组图像的诊断效能。结果：3组图像胆道梗阻定位诊断准确率比较，B2组最高[97.14%(68/70)],B1组次之[84.29%(59/70)],A组最低[65.71%(46/70)]。B1组、B2组图像定性诊断准确率分别为91.43%(64/70)、95.71%(67/70)，均高于A组[77.14%(54/70)]（均P<0.05）。B1组阳性预测值、B2组阴性预测值及敏感度分别为96.55%(28/29)、97.73%(43/44)及96.00%(24/25)，均高于A组的75.00%(21/28)、78.57%(33/42)及70.00%(21/30)（均P<0.05）。B1组、B2组图像与手术病理或内镜逆行胰胆管造影术（ERCP）的诊断一致性非常好（K=0.826,0.907）,A组图像的诊断一致性中等（K=0.529）。结论：与常规方法相比，低张CT胆道成像MinIP联合CPR可明显提升胆道梗阻的定位定性诊断效能，具有较高临床价值。

Objective:To explore the diagnostic value of MinIP combined with CPR in low tension CT cholangiography for biliary obstruction. Methods:A total of 210 patients who were clinically suspected biliary obstructive disease and underwent CT cholangiography were prospectively selected as the research subjects. All patients were randomly divided into the routine group(Group A) and the low tension groups(Group B1 and Group B2) using a random number table,with 70 patients in each group. Group A underwent CT under normal tension,and the images were post-processed with MPR. Group B1 and B2 were scanned after filling the duodenum by drinking water several times in different stages under low tension,and the images of Group B1 were post-processed with MPR,while the images of Group B2 were post-processed with MinIP and CPR. All images were analyzed,the location and qualitative diagnosis of biliary obstruction had been made,the diagnostic values were compared among the three groups. Results:Compared to the accuracy of location diagnosis for biliary obstruction among the three groups,Group B2 had the highest accuracy of 97.14%(68/70),followed by Group B1 of 84.29%(59/70),and Group A had the lowest accuracy of 65.71%(46/70). The qualitative diagnostic accuracies in Group B1 and B2 were 91.43%(64/70) and 95.71%(67/70),respectively,which were higher than the accuracy of 77.14%(54/70) in Group A(both P<0.05). The positive predictive value of Group B1,the negative predictive value and sensitivity of Group B2 were 96.55%(28/29),97.73%(43/44) and 96.00%(24/25),respectively,which were all higher than those in Group A(all P<0.05). Compared to surgical pathology or ERCP findings,Group B1 and B2 had the excellent diagnostic consistency(K=0.826,0.907),while Group A had the moderate consistency(K=0.529). Conclusions:Compared to conventional methods,MinIP combined with CPR in low tension CT cholangiography can significantly improve the location and qualitative diagnosis for biliary obstruction,and has a higher clinical value.