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胰腺和胆道结石是一种临床常见疾病,该疾病的致病因素较多,其中饮食习惯、长期炎症是最常见的病因,约占胰腺和胆道结石病的70% [1]。胰腺和胆道结石发病率较高,可引起腹部剧烈疼痛、黄疸和腹部感染等临床症状的发生,具有反复发作的特征,尽早诊断和及时治疗才可减轻其对患者生活质量的影响[2]。现阶段,胰腺和胆道结石常用的影像学诊断手段为胰胆管CT及磁共振胰胆管成像(magnetic resonance cholangiopancreatography,MRCP)等,但因成像特点不同,各种影像学诊断结果存在一定的差异,而目前临床上通常认为,与胰胆管CT比较,MRCP的诊断价值相对较高[3]。MRCP技术应用于胰腺和胆道结石的诊断,主要包括三维快速恢复快速自旋回波(three dimensional turbo spin echo retore,3D-TSERT)序列和可变翻转角的三维快速自旋回波(three dimensional sampling perfertion with application optimized contrasts using deifferent flip angle evolutions,3D-SPACE )序列扫描技术,其价值均在于MRCP对胆道结石的诊断得到了研究者的普遍认同[4-5]。但不同扫描序列的MRCP具有一定的差异,3D-TSERT和3D-SPACE序列这两种扫描技术是否存在互补性尚未见文献报道。鉴于此,本研究以确诊的胰腺和胆道结石患者为回顾性研究对象,评估3D-SPACE 联合3D-TSERT序列扫描技术在MRCP诊断结石中的价值。
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对全部患者行3D-SPACE联合3D-TSERT序列扫描结果发现,个别患者胆囊体积不同程度增大或缩小,胆囊壁增厚或无增厚,胆囊周围可见T2信号包绕或结节状T2信号(图1)。
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168例患者在手术中检出胰腺和胆道单发结石148例、双发或多发结石20例。手术中共检出结石194颗,以其为诊断标准,3D-SPACE序列检查共检出结石158颗,检出率为81.44%; 3D-TSERT序列检查共检出结石153颗,检出率为78.87% ;3D-SPACE联合3D-TSERT序列检查共检出结石191颗,检出率为98.45%。3D-SPACE 联合3D-TSERT序列的胰腺和胆道结石检出率高于3D-SPACE 、3D-TSERT序列(χ2=12.738、13.461,均P<0.01)。
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手术中共检出胰腺和胆道结石194颗,其中最大径≤0.8 cm结石105颗、>0.8 cm结石89颗。3D-SPACE、3D-TSERT序列及其二者联合检查对最大径≤0.8 cm结石的检出率分别为69.52%(73/105)、66.67%(70/105)、97.14%(102/105),二者联合的检出率高于单独检查,且差异均有统计学意义(χ2=10.684、11.374,均P<0.01);对最大径>0.8 cm结石的检出率分别为95.51%(85/89)、93.26%(83/89)、100.00%(89/89) ,二者联合的检出率略高于单独检查,但差异均无统计学意义(χ2=0.684、0.457,均P>0.05)。
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手术中共检出胰腺和胆道结石194颗,其中胆囊结石58颗、肝内胆管结石36颗、胆总管结石44颗、胆总管下端壶腹部结石30颗、胰管结石26颗。由表1可知,3D-SPACE联合3D-TSERT序列检查对不同部位的胰腺和胆道结石的检出率均高于单独检查,且差异均有统计学意义(χ2=9.105~15.715,均P<0.01)。
扫描方法 胆囊结石 肝内胆管结石 胆总管结石 胆总管下端壶腹部结石 胰管结石 3D-SPACE序列 82.76(48/58)a 83.33(30/36)a 84.09(37/44)a 76.67(23/30)a 76.92(20/26)a 3D-TSERT序列 81.03(47/58)a 77.78(28/36)a 77.27(34/44)a 80.00(24/30)a 76.92(20/26)a 3D-SPACE 联合3D-TSERT序列 100(58/58) 97.22(35/36) 100(44/44) 96.67(29/30) 96.15(25/26) 注:a表示与3D-SPACE联合3D-TSERT序列比较,差异均有统计学意义(χ2=9.105~15.715,均P<0.01)。MRCP为磁共振胰胆管成像;3D-SPACE为可变翻转角的三维快速自旋回波;3D-TSERT为三维快速恢复快速自旋回波 表 1 MRCP的不同扫描方法对不同部位的胰腺和胆道结石的检出率(%)
Table 1. The detection rate of different scanning methods of magnetic resonance cholangiopancreatography for different parts of pancreas and biliary tract calculi (%)
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ROC曲线结果显示,3D-SPACE序列诊断胰腺和胆道结石的灵敏度、特异度和准确率分别为78.46%、79.68%和79.38%,95%CI:0.718~0.884;3D-TSERT序列诊断胰腺和胆道结石的灵敏度、特异度和准确率分别为77.53% 、78.62%和76.19%,95%CI:0.704~0.862;3D-SPACE 联合3D-TSERT序列诊断胰腺和胆道结石的灵敏度、特异度和准确率分别为89.73%、90.64%和88.26%,95% CI:0.846~0.943(图2)。3D-SPACE 联合3D-TSERT序列诊断胰腺和胆道结石的灵敏度、特异度、准确率均高于3D-SPACE、3D-TSERT序列。
3D-SPACE 联合3D-TSERT序列扫描技术在MRCP诊断结石中的价值
The value of 3D-SPACE combined with 3D-TSERT sequence scanning technology in MRCP diagnosis of calculi
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摘要:
目的 评估可变翻转角的三维快速自旋回波(3D-SPACE)联合三维快速恢复快速自旋回波(3D-TSERT)序列扫描技术在磁共振胰胆管成像(MRCP)诊断结石中的价值。 方法 选取2019年1月至9月于徐州市中心医院确诊为胰腺和胆道结石的168例患者的临床资料进行回顾性研究,其中男性93例、女性75例,年龄24~70(42.91±3.20)岁。所有患者均行胰腺和胆道3D-SPACE和3D-TSERT序列的MRCP,以外科手术结果为诊断标准,分析并计算3D-SPACE、3D-TSERT序列及其二者联合对胰腺和胆道结石及不同大小、不同部位胰腺和胆道结石的检出率。采用ROC曲线分析3D-SPACE、3D-TSERT序列及其二者联合在MRCP对胰腺和胆道结石诊断中的灵敏度、特异度和准确率。2组间检出率的比较采用χ2检验。 结果 3D-SPACE联合3D-TSERT序列对胰腺和胆道结石的检出率(98.45%,191/194)高于3D-SPACE (81.44%,158/194)、3D-TSERT(78.87%,153/194)序列,且差异均有统计学意义(χ2=12.738、13.461,均P<0.01)。3D-SPACE联合3D-TSERT序列对最大径≤0.8 cm胰腺和胆道结石的检出率(97.14%,102/105)高于3D-SPACE (69.52%,73/105)、3D-TSERT(66.67%,70/105)序列,且差异均有统计学意义(χ2=10.684、11.374,均P<0.01)。3D-SPACE联合3D-TSERT序列对胆囊结石、肝内胆管结石、胆总管结石、胆总管下端壶腹部结石、胰管结石的检出率高于3D-SPACE、3D-TSERT 序列,且差异均有统计学意义(χ2=9.105~15.715,均P<0.01)。3D-SPACE联合3D-TSERT序列扫描技术对胰腺和胆道结石诊断的灵敏度、特异度和准确率分别为89.73%、90.64%和88.26%,高于3D-SPACE (78.46%、79.68%、79.38%)、3D-TSERT(77.53%、78.62%、76.19%)序列。 结论 3D-SPACE联合3D-TSERT序列扫描技术在MRCP中对不同部位胰腺和胆道结石(尤其微小结石)的诊断中具有很高的临床应用价值。 -
关键词:
- 磁共振成像 /
- 3D-SPACE 序列 /
- 3D-TSERT序列 /
- 结石 /
- 胰腺 /
- 胆道
Abstract:Objective To evaluate the value of variable flip angle three dimensional sampling perfertion with application optimized contrasts using deifferent flip angle evolutions (3D-SPACE) combined with three dimensional turbo spin echo retore (3D-TSERT) sequence scanning technology in the diagnosis of calculi using magnetic resonance cholangiopancreatography (MRCP). Methods A retrospective study was conducted on the clinical data of 168 patients diagnosed with pancreatic and biliary calculi in the Central Hospital of Xuzhou from January to September 2019. The patients comprised 93 males and 75 females, aged 24–70(42.91±3.20) years, who underwent pancreatic and biliary tract 3D-SPACE-sequence and 3D-TSERT-sequence MRCP. The surgical result was used as the diagnostic standard. 3D-SPACE-sequence, 3D-TSERT-sequence, and their combination were used to determine and analyze different sizes of calculi in the pancreas and biliary tract. The three methods were compared in terms of their detection rates of pancreatic and biliary tract calculi. Receiver operating characteristic curve was used to analyze the sensitivity, specificity, and accuracy of 3D-SPACE, 3D-TSERT sequence, and their combination in the diagnosis of pancreatic and biliary tract calculi in MRCP. χ2 test was used to compare the detection rates between the two groups. Result The detection rate of 3D-SPACE combined with 3D-TSERT sequence for pancreatic and biliary calculi (98.45%, 191/194) was higher than those of 3D-SPACE-sequence (81.44%, 158/194) and 3D-TSERT-sequence (78.87%, 153/194), and the difference was statistically significant (χ2=12.738, 13.461; both P<0.01). The detection rate of 3D-SPACE combined with 3D-TSERT sequence for pancreas and biliary tract calculi with maximum diameter ≤0.8 cm (97.14%, 102/105) was higher than those of 3D-SPACE-sequence (69.52%, 73/105) and 3D-TSERT-sequence (66.67%, 70/105), and the difference was statistically significant (χ2=10.684, 11.374; both P<0.01). The detection rates of 3D-SPACE combined with 3D-TSERT sequence for gallbladder calculi, intrahepatic bile duct calculi, common bile duct calculi, lower common bile duct ampullary calculi, and pancreatic duct calculi were higher than those of 3D-SPACE-sequence and 3D-TSERT-sequence, and the differences were statistically significant (χ2=9.105–15.715, all P<0.01). The sensitivity, specificity, and accuracy of 3D-SPACE combined with 3D-TSERT sequence for the diagnosis of pancreatic and biliary calculi were 89.73%, 90.64%, and 88.26%, respectively, which were higher than those of 3D-SPACE-sequence (78.46%, 79.68%, and 79.38%) and 3D-TSERT-sequence (77.53%, 78.62%, and 76.19%). Conclusion 3D-SPACE combined with 3D-TSERT sequence scanning technology has high clinical application value in the diagnosis of calculi (especially small calculi) through the MRCP of different parts of the pancreas and biliary tract. -
Key words:
- Magnetic resonance imaging /
- 3D-SPACE sequence /
- 3D-TSERT sequence /
- Calculi /
- Pancreas /
- Biliary tract
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表 1 MRCP的不同扫描方法对不同部位的胰腺和胆道结石的检出率(%)
Table 1. The detection rate of different scanning methods of magnetic resonance cholangiopancreatography for different parts of pancreas and biliary tract calculi (%)
扫描方法 胆囊结石 肝内胆管结石 胆总管结石 胆总管下端壶腹部结石 胰管结石 3D-SPACE序列 82.76(48/58)a 83.33(30/36)a 84.09(37/44)a 76.67(23/30)a 76.92(20/26)a 3D-TSERT序列 81.03(47/58)a 77.78(28/36)a 77.27(34/44)a 80.00(24/30)a 76.92(20/26)a 3D-SPACE 联合3D-TSERT序列 100(58/58) 97.22(35/36) 100(44/44) 96.67(29/30) 96.15(25/26) 注:a表示与3D-SPACE联合3D-TSERT序列比较,差异均有统计学意义(χ2=9.105~15.715,均P<0.01)。MRCP为磁共振胰胆管成像;3D-SPACE为可变翻转角的三维快速自旋回波;3D-TSERT为三维快速恢复快速自旋回波 -
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