磁共振胰胆管造影等影像学检查联合血清CA19-9在良恶性胆管狭窄鉴别诊断中的应用研究
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摘要
目的研究磁共振胰胆管造影(MRCP)、腹部增强计算机断层扫描(CT)联合血清CA19-9对良恶性胆管狭窄的鉴别诊断价值。方法回顾性分析2016年1月至2018年7月该院收治的82例良性胆管狭窄(良性组)和26例恶性胆管狭窄(恶性组)患者病历资料,以组织病理学诊断结果为"金标准",分析MRCP、腹部增强CT联合血清CA19-9对良恶性胆管狭窄鉴别诊断效能。结果恶性组血清CA19-9水平明显高于良性组(P<0.05)。MRCP、腹部增强CT及血清CA19-9联合检查对良恶性胆管狭窄的鉴别诊断灵敏度为88.46%,特异度为96.34%,联合诊断受试者工作特征曲线下面积为0.924,鉴别诊断效能优于三项检查独立诊断。结论 MRCP、腹部增强CT联合血清CA19-9可有效提高对良恶性胆管狭窄的鉴别诊断灵敏度及特异度,具有较高的临床应用价值。
Objective To explore the differential diagnostic value of magnetic resonance cholangiopancreatography(MRCP),abdominal enhanced CT combined with serum CA19-9 on malignant and benign biliary stricture.Methods Data of 82 cases with benign biliary stricture and 26 cases with malignant biliary stricture,admitted from Jan.2016 to Jul.2018 in this hospital,were retrospectively analyzed.Postoperative histological diagnosis was taken as gold standard to evaluate the differential diagnostic performance of MRCP,abdominal enhanced CT and serum CA19-9 on malignant and benign biliary stricture.Results The level of serum CA19-9 in patients with malignant biliary stricture was significantly higher than patients with benign biliary stricture(P<0.05).The sensitivity and specificity,and area under receiver operating curve of combined application of MRCP,abdominal enhanced CT and serum CA19-9 for the differential diagnosis of malignant and benign biliary stricture were 88.46%,96.34% and 0.924,which were greater than the individual test.Conclusion Combined detection of MRCP,abdominal enhanced CT and serum CA19-9 could be with fine differential diagnostic performance on malignant and benign biliary stricture.
Objective To explore the differential diagnostic value of magnetic resonance cholangiopancreatography(MRCP),abdominal enhanced CT combined with serum CA19-9 on malignant and benign biliary stricture.Methods Data of 82 cases with benign biliary stricture and 26 cases with malignant biliary stricture,admitted from Jan.2016 to Jul.2018 in this hospital,were retrospectively analyzed.Postoperative histological diagnosis was taken as gold standard to evaluate the differential diagnostic performance of MRCP,abdominal enhanced CT and serum CA19-9 on malignant and benign biliary stricture.Results The level of serum CA19-9 in patients with malignant biliary stricture was significantly higher than patients with benign biliary stricture(P<0.05).The sensitivity and specificity,and area under receiver operating curve of combined application of MRCP,abdominal enhanced CT and serum CA19-9 for the differential diagnosis of malignant and benign biliary stricture were 88.46%,96.34% and 0.924,which were greater than the individual test.Conclusion Combined detection of MRCP,abdominal enhanced CT and serum CA19-9 could be with fine differential diagnostic performance on malignant and benign biliary stricture.
引文
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[15]ROMAGNUOLO J,BARDOU M,RAHME E,et al.Magnetic resonance cholangiopancreatography:a meta-analysis of test performance in suspected biliary disease[J].Ann Intern Med,2003,139(7):547-557.
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[17]史彬,刘影,曾飞雁,等.磁共振胆胰管造影联合增强CT对良恶性胆道狭窄的鉴别价值[J].中国医学影像学杂志,2015,23(8):597-601.
[2]LI N,LIU C,BI W,et al.MRCP and 3DLAVA imaging of extrahepatic cholangiocarcinoma at 3T MRI[J].Clin Radiol,2012,67(6):579-586.(下转第1658页)
[3]谢立旗,刘莉娜,刘健,等.胆总管癌MSCT动态增强表现及应用价值[J].医学影像学杂志,2014,24(5):772-774.
[4]SINGH S,TANG SJ,SREENARASIMHAIAH J,et al.The clinical utility and limitations of serum carbohydrate antigen(CA19-9)as a diagnostic tool for pancreatic cancer and cholangiocarcinoma[J].Dig Dis Sci,2011,56(8):2491-2496.
[5]马原,孙备,姜洪池.血清CA19-9对诊断和治疗胆胰系统疾病的临床意义[J].中华消化外科杂志,2013,34(11):888-890.
[6]HU B,GAO D,WU J,et al.Intraductal radiofrequency ablation for refractory benign biliary stricture:pilot feasibility study[J].Digest Endosc,2014,26(4):581-585.
[7]KUCUKAY F,OKTEN RS,YURDAKUL M,et al.Percutaneous management of malignant biliary disease:factors influencing the ability to overcome the stricture[J].Diagn Interv Radiol,2011,17(2):169-173.
[8]张宏昭,任利.良恶性胆道狭窄的临床诊断现状[J].世界最新医学信息文摘,2015,15(67):32-32.
[9]ZHOU Y,LIU S,WU L,et al.Survival after surgical resection of distal cholangiocarcinoma:a systematic review and meta-analysis of prognostic factors[J].Asian J Surg,2017,40(2):129-138.
[10]王鹏儒,陈浩宇,陈洁.消化内镜在胆管狭窄诊治中的应用[J].胃肠病学,2018,22(1):52-55.
[11]李少杰,徐丽艳,伏树奇.低场MRI及MRCP在肝外胆管梗阻性病变中的诊断价值[J].安徽医药,2015,19(9):1737-1739.
[12]黄凯.肿瘤标志物CEA、CA19-9在消化系统恶性肿瘤检测中的应用价值[J].临床医学研究与实践,2018,3(25):13-14.
[13]刘兰凤,田斌,刘海燕,等.肿瘤标志物CEA、AFP、CA19-9和CA72-4的检测在消化系统恶性肿瘤中的应用[J].国际检验医学杂志,2017,38(5):596-597.
[14]陈才书.血清CA19-9的检测及在消化系统疾病诊断中的临床意义[J].世界最新医学信息文摘,2017,17(65):131.
[15]ROMAGNUOLO J,BARDOU M,RAHME E,et al.Magnetic resonance cholangiopancreatography:a meta-analysis of test performance in suspected biliary disease[J].Ann Intern Med,2003,139(7):547-557.
[16]TILLICH M,MISCHINGER HJ,PREISEGGER KH,et al.Multiphasic helical CT in diagnosis and staging of hilar cholangiocarcinoma[J].Ajr Am J Roentgenol,1998,171(3):651-658.
[17]史彬,刘影,曾飞雁,等.磁共振胆胰管造影联合增强CT对良恶性胆道狭窄的鉴别价值[J].中国医学影像学杂志,2015,23(8):597-601.