磁共振胰胆管成像联合CT动态增强扫描诊断胆道狭窄性质的临床价值*

Clinical significance of MRCP combined with DCE-CT in diagnosis of biliary stenosis*

摘要:

目的 探讨联合磁共振胰胆管成像（MRCP）及CT动态增强扫描相关指标诊断胆道狭窄性质的有效性。方法 选取海南医学院第一附属医院95例胆道狭窄患者作为研究对象，根据手术病理结果将患者分为良性胆道狭窄组（48例）、恶性胆道狭窄组（47例）。收集两组患者MRCP及CT动态增强扫描检查指标，比较两组患者检测指标及基线资料存在的差异，对产生差异的指标进行多因素Logistic回归。绘制受试者操作特征（ROC）曲线分析各指标单用及联合时诊断胆道狭窄性质的效能。结果 多因素Logistic回归结果显示，狭窄段壁厚（OlR=3.246，95% CI：2.228，4.729）、狭窄段管径（OlR=0.801，95% CI：0.682，0.941）、门静脉期狭窄段管壁强化程度（OlR=2.135，95% CI：1.503，3.032），以及延迟期狭窄段管壁强化程度（OlR=1.835，95% CI：1.344，2.506）可成为诊断良恶性胆道狭窄的指标。ROC曲线结果表明，狭窄段壁厚、狭窄段管径、门静脉期狭窄段管壁强化程度、延迟期狭窄段管壁强化程度诊断疾病的曲线下面积（AUC）分别为0.774、0.817、0.838和 0.796。狭窄段管径、门静脉期狭窄段管壁强化程度及延迟期狭窄段管壁强化程度联合诊断的AUC最高，为0.902。结论 MRCP联合CT动态增强扫描相关指标可以提高诊断良恶性胆道狭窄的诊断效能。

Abstract:

Objective To investigate the clinical significance of MRCP combined with DCE-CT in the diagnosis of biliary stenosis. Methods Totally 95 patients who were admitted into our hospital with biliary stenosis were selected as the study subjects. The patients were divided into benign biliary stenosis group (n?=?48) and malignant biliary stenosis group (n?=?47) based on pathological confirmation. The MRCP and DCE-CT related information were recorded. Multivariate logistic regression was applied to identify diagnostic sensitivity and specificity. Results Multivariate logistic regression analysis identified wall thickness of the stenotic segment (OlR?=?3.246, 95% CI: 2.228, 4.729), the stenosis of the stenosis (OlR?=?0.801, 95% CI: 0.682, 0.941), the portal venous phase (OlR?=?2.135, 95% CI: 1.503, 3.032), and the stenosis of the stenotic segment of the delayed phase (OlR?=?1.835, 95% CI: 1.344, 2.506) as differentially diagnostic indicators of benign and malignant biliary stenosis. ROC results showed that the area under the curve (AUC) of wall thickness, narrow segment diameter, stenosis of the portal stenosis segment, and the severity of the stenosis in the delayed phase were 0.774, 0.817, 0.838 and 0.796, respectively. AUC for combination of wall thickness, narrow segment diameter, stenosis of the portal stenosis segment, and the severity of the stenosis in the delayed phase was 0.902. Conclusions MRCP combined with DCE-CT provides a novel tool for differential diagnosis of benign and malignant biliary stenosis.