多层螺旋CT阴性法胆道成像对胆道梗阻的诊断价值
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摘要
目的:探讨多层螺旋CT(MSCT)联合阴性法胆道成像(N-CTC)对胆道梗阻性疾病的诊断价值;比较和评价MSCT/N-CTC与磁共振(MR)/胰胆成像(MRCP)对胆道梗阻的定性诊断价值的一致性。方法:连续收集60例怀疑胆道梗阻的病例进行MSCT扫描及N-CTC胆道成像;其中49例胆道梗阻的病例于一周内同时行MSCT扫描、MR及MRCP检查。N-CTC以曲面重建(curved planar reformation,CPR)技术和最小密度投影(minimum intensity projection,Min-IP)技术进行图像重建;MRCP以最大强度投影(maximum intensity projection,MIP)技术和容积再现(volume rendering,VR)技术进行图像重建。将影像学诊断结果与手术和/或病理结果对照,计算60例病例的灵敏度、特异度、准确率、预测值和似然比来评价MSCT/N-CTC对胆道梗阻定位、定性的诊断价值;49例病例组以受试者工作特性(ROC)曲线下面积Az及Kappa指数来评价MSCT/N-CTC与MR/MRCP定性诊断的一致性。结果:所有纳入病例均顺利完成影像检查,胆道显示满意,MSCT轴位像结合CPR及Min-IP重建图像对胆道梗阻的定位和定性诊断的灵敏度分别为89.86%和88.64%,特异度分别为94.59%和81.25%,准确率分别为92.78%和86.67%,阳性预测值分别为91.18%和92.86%,阴性预测值分别为93.75%和72.22%,阳性似然比分别为16.61和4.73,阴性似然比分别为0.11和0.14。MSCT/N-CTC与MR/MRCP定性诊断的Az分别为0.9423及0.9448,P值为0.44>0.05。Kappa指数为0.8494,(α=0.05)。结论:N-CTC结合轴位图像对胆道梗阻性疾病的定位、定性有较高准确性,定性诊断与MR/MRCP比较有较好的一致性。MSCT/N-CTC是较实用的无创性胆道检查方法。
Objective: To evaluate the value of MSCT combined negative CT cholangiography (N-CTC) in diagnosis of bile duct obstructive disease,and to compare the MSCT/ N-CTC with MR/ MR cholangiopancreatography (MRCP) in differential diagnosis of bile duct obstruction.Methods: Consecutive 60 cases suspected of bile duct obstruction were underwent MSCT scan. 49 cases of bile duct obstruction underwent MSCT and MR scan simultaneously. Curved planar reformation(CPR) and minimum intensity projection(Min-IP) were used in N-CTC,while maximum intensity projection(MIP) and volume rendering (VR) were used in MRCP. Combined with their multi-axial and multi-sequence image to reveal the diseases. The imaging results were compared with that of surgical / pathology. The reference index for evaluation of MSCT/ N-CTC include sensitivity(SEN),specificity(SPE),accuracy(ACC), predictive value (PV) and likelihood ratio (LR). Consistency of MSCT/ N-CTC correlated with MR/ MRCP were the area under the receiver operating characteristic(ROC)curve (Az) and Kappa index . Results: All patients were examined smoothly and showed bile ducts obstruction. The SEN, SPE,ACC, positive predictive value (PPV),negative predictive value (NPV),positive likelihood ratio (PLR) and negative likelihood ratio (NLR) to determine the location and disease of obstruction of bile duct were SEN 89.86% and 88.64%, SPE 94.59% and 81.25%,ACC 92.78% and 86.67%, PPV 91.18% and 92.86%,NPV 93.75% and 72.22%, PLR 16.61 and 4.73,NLR 0.11 and 0.14, respectively. Az of MSCT/ N-CTCP and MR/ MRCP were 0.9423 and 0.9448 respectively,P=0.44>0.05. Kappa index of MSCT/ N-CTC compared with MR/ MRCP was 0.8494,(α=0.05).Conclusions: MSCT/N-CTC can accurately determine the location of bile duct obstruction and make clear the reason. It is a very potential non-invasive method to detect the bile duct obstructive and diagnose the disease.
Objective: To evaluate the value of MSCT combined negative CT cholangiography (N-CTC) in diagnosis of bile duct obstructive disease,and to compare the MSCT/ N-CTC with MR/ MR cholangiopancreatography (MRCP) in differential diagnosis of bile duct obstruction.Methods: Consecutive 60 cases suspected of bile duct obstruction were underwent MSCT scan. 49 cases of bile duct obstruction underwent MSCT and MR scan simultaneously. Curved planar reformation(CPR) and minimum intensity projection(Min-IP) were used in N-CTC,while maximum intensity projection(MIP) and volume rendering (VR) were used in MRCP. Combined with their multi-axial and multi-sequence image to reveal the diseases. The imaging results were compared with that of surgical / pathology. The reference index for evaluation of MSCT/ N-CTC include sensitivity(SEN),specificity(SPE),accuracy(ACC), predictive value (PV) and likelihood ratio (LR). Consistency of MSCT/ N-CTC correlated with MR/ MRCP were the area under the receiver operating characteristic(ROC)curve (Az) and Kappa index . Results: All patients were examined smoothly and showed bile ducts obstruction. The SEN, SPE,ACC, positive predictive value (PPV),negative predictive value (NPV),positive likelihood ratio (PLR) and negative likelihood ratio (NLR) to determine the location and disease of obstruction of bile duct were SEN 89.86% and 88.64%, SPE 94.59% and 81.25%,ACC 92.78% and 86.67%, PPV 91.18% and 92.86%,NPV 93.75% and 72.22%, PLR 16.61 and 4.73,NLR 0.11 and 0.14, respectively. Az of MSCT/ N-CTCP and MR/ MRCP were 0.9423 and 0.9448 respectively,P=0.44>0.05. Kappa index of MSCT/ N-CTC compared with MR/ MRCP was 0.8494,(α=0.05).Conclusions: MSCT/N-CTC can accurately determine the location of bile duct obstruction and make clear the reason. It is a very potential non-invasive method to detect the bile duct obstructive and diagnose the disease.
引文
[1]黄志强.肝门部胆管癌外科治疗——我们要走向何方? [J].肝胆外科杂志,2003,11(5):321-322.
[2]刘振春.胆管癌的影像诊断[J].中国实用外科杂志,1994,14(3):162-166.
[3]顾军,周康荣,彭卫军,等.螺旋CT胆道造影及其三维重建的临床应用价值[J] .临床放射学杂志,2000,19(8):490-494.
[4]宋光义,庞瑞麟.螺旋CT胆道成像临床应用及评价[J]. (综述).云南医药, 2005,26(2):150-155.
[5]周建华,操隆辉,陈孝岳,等.超声与CT诊断恶性肿瘤致阻塞性黄疸的价值[J].中国超声医学杂志,2003,19(10):763-765.
[6] Hekimoglu K.,Ustundag Y.,Dusak A.,et al. MRCP vs ERCP in the evaluation of biliary pathologies: Review of current literature. Journal of Digestive Diseases,2008, 9(3):162-169.
[7] Xu AM, Cheng HY, Jiang WB, et al.Multi - slicethree-dimensional spiral CT cholangiography :a new technique for diagnosis biliary diseasea [J]. Hepatobiliary Pancreat Dis Int,2002,1(4):595-603.
[8] Klein HM, Wein B, Truong S, et al. Computer tomographic cholangiography using spiral scanning and 3D image processing[J].Br J Radiol,1993,66(9):762-767.
[9]李建生,李康印,陈虎义,等.螺旋CT胆道立体成像对胆道梗阻性疾病诊断价值的研究[J].临床放射学杂志,2001,20(10):774-776.
[10]Stockberger SM,Sheman S,Kopecky KK.Helical CT Cholan- geography [J].Abdom Imaging,1996,21(9):82-101.
[11]龚静山.螺旋CT胆系成像[J].国外医学临床放射学分册,1999,1:18-20
[12]Gillams A,Gardener J,Richard R,et al. Three-dimensional computed tomography cholangiography:a new technique for biliary tract imaging[J].Br J Radiol,1994,67(2):445-448.
[13]张追阳,丁乙,倪才方,等.阴性法螺旋CT胰胆管造影与直接胆胰管造影比较[J].中华放射学杂志, 2002,36(7):613-617.
[14]王耀程,魏经国,白建军,等.应用螺旋CT胆道造影诊断胆管阻塞的可靠性研究[J].实用放射学杂志,2002,18(2):84-87.
[15]Lee MG,Lee HU,Kim MH,et al. Extrahepatic biliary disease: 3D MR cholangiopancreatography computed with endoscopic retrograde cholangio gancreat ography[J]. Radiology,1997,202(3):663-669.
[16]Baron RL. Computed tomography of the bile duct (review) [J]. Semin Roentgenol,1997,32(1):172-187.
[17]梁颖,蒋涛,翟仁友,等.多层螺旋CT多平面重组技术在胆总管结石中的应用[J].中国医学影像技术,2006,22(9):1376-1377.
[18]王礼同,李澄,顾振,等.MSCT曲面重组阴性法胆管成像与MRCP对肝外胆管癌的诊断比较[J].中国医学影像技术,2007,23(8):1194-1196.
[19]贺锋,岳建国,蔡毅,等.MSCT阴性法胰胆管造影诊断低位胆管梗阻的评价[J].放射学实践2003 18(11):819-821.
[20]梁万年,王存亮(编译).如何应用四格表评估诊断试验的价值[J].中国全科医学,2005,8(2):288-289
[21]林果为.诊断试验的研究与评价[J].诊断学理论与实践.2003,2(1):附1-4.
[22]王滨有.诊断试验及其评价[J].中国地方病学杂志. 2004,23(11):630-631.
[23]Greenbreg M,Rubin JM,Greenbreg BM.Appearance of the gallbladder and biliary tree by CT cholangiography[J]. JCAT,1983,7:788-794.
[24]刘小新,郭俊渊,胡煜升.胆系造影CT对胆系疾病的诊断[J].临床放射学杂志,1995,14(1):27.
[25]Sahani D,Mehta A,Blake M,et al.Preoperative hepatic vascular evaluation with CT and MR angiography:implications for surgery [J].RadioGraphics 2004,24(5):1367-1380.
[26]Vannier MW, Marsh JL.Three-dimensional imaging ,surgical planning and image-guided therapy[J].Radiol Clin North Am,1996,34(3):545.
[27]Rydberg J,Buckwalter KA,caldemeyer KS,et al.Multi-slice CT:scanning techniques and clinical applications[J].Radiographics,2000,20:1787-1806.
[28]Park SJ,Han J K,KIM TK,et al .Three-dimensional spiral CT cholangiography with minimum intensity projection in patients with suspected obstructive biliary disease:comparison with percutaneous transhepatic cholangiography [J].Abdom Imaging,2001,26(3):281-284.
[29]张追阳,丁乙,胡春洪,等.阴性法螺旋CT胰胆管造影成像参数的研究[J].中华放射学杂志,2001,35(2):145-147.
[30]彭卫斌,陈国强,赵亮,等多.层螺旋CT胆道成像技术的临床应用[J].实用放射学杂志,2005,21(11):1166-1168.
[31]Kim HC,Park SJ,Park SI, et al. Multislice CT cholan-giography using thin-slab minimum intensity projection and multiplanar reformation in the evaluation of patients with suspected biliary obstruction Preliminary experience[J]. Radiology,2005,29(1):46-54.
[32]薛华丹,金征宇,廖泉,等.多层螺旋CT无胆道造影剂胰胆管成像[J].中国医学科学院学报.2004,26(3):268-273.
[33]王书智,陈马昊,冯敏,等.螺旋CT曲面成像在胆道梗阻疾病中的应用[J].实用医技杂志,2003,10(6):559-561.
[34]Fleischmannd,Hin GH,Schofl R,et al.Three-dimensional spiral CT cholangiography in patients with suspected obstructive biliary disease: comparison with endoscopic retrograde cholangiography[J]. Radiology,1996,198(3):861-868.
[35]Kim HC,Park SJ,Park SI, et al . Multislice CT cholan-giography using thin-slab minimum intensity projection and multiplanar reformation in the evaluation of patients with suspected biliary obstruction Preliminary experience[J]. Radiology,2005,29(1):46-54.
[36]Zeman BK,Berman PM,Silverman PM,et al. Biliary tract: three dimensional helical CT without cholangiographic contrast material[J]. Radiology,1995,196(3):865-867.
[37]张追阳,丁乙,沈袁良,等.螺旋CT胰胆管阴性成像诊断胆管高位梗阻疾病[J].临床放射学杂志,2002,21(3):210-212.
[38]杨复宾,王藏海,全冠民.正常瓦特壶腹部低张螺旋CT表现[J].中国医学影像技术,2007,23(4):575-577.
[39]孙晓伟,王霄英,邹英华,等.梗阻性黄疸患者MRCP及肝胆断层MR检查对于PTC及PTBD指导作用的分析[J].中国医学影像技术,2005,21(3):375-377.
[40]Sang Won Kim,Do Hyun Park,Hyeong Cheol Shin,et al. Duplication of the Extrahepatic Bile Duct in Association with Choledocholithiasis as Depicted by MDCT[J]. Korean J Radiol 2008;9:550-554.
[41]方义海,沈小健,黄文才.多层螺旋CT胆道成像对48例胆道病变的诊断价值分析[J].苏州大学学报(医学版) 2006,26(5):851-852.
[42]Pickuth D. Radiologic diagnosis of common bile duct stones [J]. Abdom Imaging ,2000,25(6):618-621.
[1]周宁新,黄志强.肝门胆管癌外科治疗方式的选择和预后[J].腹部外科,1993,6(3):43-45.
[2]黄志强.肝门部胆管癌外科治疗——我们要走向何方? [J].肝胆外科杂志,2003,11(5):321-322.
[3]顾军,周康荣,彭卫军,等.螺旋CT胆道造影及其三维重建的临床应用价值[J] .临床放射学杂志,2000,19(8):490-494.
[4] Stockberger SM, Wass JL, Sherman S,et al. Intravenous cholangiography with helical CT: comparion with endoscopic retrograde cholangiography [J]. Radiology, 1994,192(2):675-680.
[5]林建华,李朝龙,贺旭,等.经皮肝胆囊穿刺胆道造影与道行胰胆管造影应用价值比较[J].肝胆胰外科杂志,2000,12(4):180-181.
[6]周建华,操隆辉,陈孝岳,等.超声与CT诊断恶性肿瘤致阻塞性黄疸的价值[J].中国超声医学杂志,2003,19(10):763-765.
[7]宋光义,庞瑞麟.螺旋CT胆道成像临床应用及评价[J].(综述).云南医药, 2005,26(2):150-155.
[8] Xu AM ,Cheng HY,Jiang WB , et al . Multi - slicethree - dimensional spiral CT cholangiography: a new technique for diagnosis biliary diseasea [J]. Hepatobiliary Pancreat Dis Int ,2002,1(4):595-603.
[9]张追阳,丁乙,倪才方,等.阴性法螺旋CT胰胆管造影与直接胆胰管造影比较[J].中华放射学杂志, 2002,36(7):613-617.
[10]王耀程,魏经国,白建军,等.应用螺旋CT胆道造影诊断胆管阻塞的可靠性研究[J].实用放射学杂志,2002,18(2):84-87.
[11]陈汉,吴孟超.黄疸病人进行PTC及PTCD应注意的问题[J].实用外科杂志, 1998,8(11):570.
[12]任克,王强,徐克,等.多层螺旋CT多层面重建技术在胆道梗阻性疾病诊断中的应用[J].中国医学影像技术,2005,21(11):1720-1722.
[13]方义海,沈小健,黄文才.多层螺旋CT胆道成像对48例胆道病变的诊断价值分析[J].苏州大学学报(医学版),2006,26(5):851-852.
[14]Pickuth D.Radiologic diagnosis of common bile duct stones [J]. Abdom Imaging,2000,25(6):618-621.
[15]Cabada GT, Sarria OL, Martineez MT, et al. Helical CT cholangiography in the evaluation of the biliary tract: application to the diagnosis of choledo cholithiasis[J].Abdom Imaging,2002,27(1):61-70.
[16]王晓波,徐来喜,张锡友,等.PTC诊断梗阻性黄疸的价值(附126例报告) [J].四川解剖学杂志,1999,7(3):211-212.
[17]Vannier MW, Marsh JL. Three-dimensional imaging ,surgical planning and image-guided therapy[J]. Radiol Clin North Am,1996,34(3):545
[18]Rydberg J,Buckwalter KA,caldemeyer KS,et al. Multi-slice CT: scanning techniques and clinical applications [J]. Radiographics,2000,20:1787-1806.
[19]楼俭茹,刘文亚,温浩,等.多层螺旋CT肝脏血管成像技术的应用研究[J].新疆医科大学学报,2004,27(6):555-557.
[20]Bibao MK, Dotter CT, LEE TG,et al.Complications of endoscopic retrograde cholangiopancreatography (ERCP).A study of 10000 cases [J]. Gaste oentero logy, 1976,70(3):314-317.
[21]Vam Beers BE,Lacrosse M,Trigaux M,et al. Noninvasive imaging of biliary tree before or after laparoscopic cholecystectomy:use of three-dimensional spiral CT cholangiography [J]. ATR,1994,162(2):1331- 1335.
[22]Klein HM,Wein B,Truong S, et al. Computer tomographic cholangiography using spiral scanning and 3D image processing [J]. Br J Radiol,1993,66(9):762-767.
[23]李建生,李康印,陈虎义,等.螺旋CT胆道立体成像对胆道梗阻性疾病诊断价值的研究[J].临床放射学杂志, 2001,20(10):774-776.
[24]Gillams A,Gardener J,Richard R,et al. Three-dimensional computed tomography cholangiography: a new technique for biliary tract imaging[J]. Br J Radiol,1994,67(2):445-448.
[25]张追阳,丁乙,沈袁良,等.螺旋CT胰胆管阴性成像诊断胆管高位梗阻疾病[J].临床放射学杂志,2002,21(3):210-212.
[26]Park SJ,Han J K,Kim TK,et al . Three-dimensional spiral CT cholangiography with minimum intensity projection in patients with suspected obstructive biliary disease: comparison with percutaneous transhepatic cholangiography [J]. Abdom Imaging,2001,26(3):281-284.
[27]Kim HC,Park SJ,Park SI, et al. Multislice CT cholan-giography using thin-slab minimum intensity projection and multiplanar reformation in the evaluation of patients with suspected biliary obstruction Preliminary experience[J]. Radiology,2005,29(1):46-54.
[28]Fleischmann D , Hing H , Schofl R , et al . Three-dimensional spiral CT cholangiography in patients with suspected obstructive biliary disease: comparisonwith endoscopic retrograde cholangiography [J].Radiology, 1996,198(3):861-868.
[29]王静,刘文亚,党军.多层螺旋CT血管成像对肝癌的评价及临床应用[J].新疆医科大学学报,2008,31(2):195-196.
[30]沈小健,龚建平,蔡庆,等.多层螺旋CT胆管MPR与MRCP的初步对照研究[J].实用放射学杂志,2006,22(11):1358-1361.
[31]矫娜,孔祥泉,史河水,等.肝门部胆管癌CT与MRI的诊断价值.临床放射学杂志,2006,25(7):639-643.
[32]贺锋,岳建国,蔡毅,等.MSCT阴性法胰胆管造影诊断低位胆管梗阻的评价[J].放射学实践2003,18(11):819-821.
[33]王礼同,李澄,顾振,等.MSCT曲面重组阴性法胆管成像与MRCP对肝外胆管癌的诊断比较[J].中国医学影像技术,2007,23(8):1194-1196.
[34]周奉学,王建安,周毅.恶性梗阻性黄疸的CT征象分析(附50例报告)[J].实用放射学杂志,2004,20(7):605-607.
[35]王书智,陈马昊,冯敏,等.螺旋CT曲面成像在胆道梗阻疾病中的应用[J].实用医技杂志,2003,10(6):559-561.
[36] Hong KC, Freeny PC. Pancreaticoduodenal arcades and doseal pancreatic artery: three-dimensional volume rendering, maximum intensity projection, and shaded -surface display [J]. AJR,1999,172(4):925-931.
[37]李建生,李康印,陈虎义,等.螺旋CT胆道立体成像对胆道梗阻性疾病诊断价值的研究[J].临床放射学杂志, 2001,20(10):774-776.
[38]Raptopoulos V,Prassopoulos P,Chuttani R,et al.Multiplanar CT pancreatography and distal cholangiography with minimum intensity projections [J]. Radiology,1998,207(2):317-324.
[39]Zandrino F,Benzi L, Ferretti ML, et al. Multislice CT cholangiography without biliary contrast agent: technique and initial clinical results in the assessment of patients with biliary obstruction [J]. Euro Radiol,2002,12(5):1155-1161.
[40]熊燕,周翔平,陈宪,等.MRI、US、CT对胆道良恶性梗阻鉴别诊断的对比研究[J].实用放射学杂志,2006,22(9):1071-1074.
[41]殷信道,王利伟,卢玲铨,等.MRCP结合常规MRI诊断恶性肿瘤性胆道梗阻的临床应用[J].中国医学影像技术,2007,23(11):1670-1672.
[42]付建设,同志勤,赵京龙,等.磁共振胰胆管成像诊断胆系梗阻性疾病的临床评价[J].实用放射学杂志,2003,19(6):510-513.
[43]Mortele KJ,Ros PR. Anatomic variants of the biliary tree: MR cholangiographic findings and clinical applications [J].AJR Am J Roentgenol 2001,177(2):389–394.
[44]Hartman EM, Rartsh MA.MR cholangiography [J]. Magn Reson Imaging Clin N Am, 2001,9(4):841-855.
[45]孙晓伟,王霄英,邹英华,等.梗阻性黄疸患者MRCP及肝胆断层MR检查对于PTC及PTBD指导作用的分析[J].中国医学影像技术,2005,21(3):375-377.
[46]Leni D, Trevisan R,Vanzulli A.Imaging of donor liver transplantation [J].Radiol Med(Torino),2004,107(1-2):58-68.
[47]Limanond P,Raman SS,Ghobrial RM,et al.Preoperative imaging in adult-to-adult living related liver transplant donors:what surgerons want to know [J]. J Comput Assist Tomogr,2004,28(2):149-157.
[48]Yeh BM, Breiman RS, Taouli B, et al. Billiary tract depiction in living potential liver donors: comparison of conventional MR, mangarfodipir trisodium - enhanced excretory MR, and multi-detector row CT cholangiography-initial experience [J] . Radiology,2004,230(3):715-723.
[49]Miller GA, Yeh BM, Breiman RS, et al. Use of CT cholangiography to evaluate the biliary tract after liver transplantation: initial experience [J]. Liver Transpl,2004,10(8):1065-1068.
[2]刘振春.胆管癌的影像诊断[J].中国实用外科杂志,1994,14(3):162-166.
[3]顾军,周康荣,彭卫军,等.螺旋CT胆道造影及其三维重建的临床应用价值[J] .临床放射学杂志,2000,19(8):490-494.
[4]宋光义,庞瑞麟.螺旋CT胆道成像临床应用及评价[J]. (综述).云南医药, 2005,26(2):150-155.
[5]周建华,操隆辉,陈孝岳,等.超声与CT诊断恶性肿瘤致阻塞性黄疸的价值[J].中国超声医学杂志,2003,19(10):763-765.
[6] Hekimoglu K.,Ustundag Y.,Dusak A.,et al. MRCP vs ERCP in the evaluation of biliary pathologies: Review of current literature. Journal of Digestive Diseases,2008, 9(3):162-169.
[7] Xu AM, Cheng HY, Jiang WB, et al.Multi - slicethree-dimensional spiral CT cholangiography :a new technique for diagnosis biliary diseasea [J]. Hepatobiliary Pancreat Dis Int,2002,1(4):595-603.
[8] Klein HM, Wein B, Truong S, et al. Computer tomographic cholangiography using spiral scanning and 3D image processing[J].Br J Radiol,1993,66(9):762-767.
[9]李建生,李康印,陈虎义,等.螺旋CT胆道立体成像对胆道梗阻性疾病诊断价值的研究[J].临床放射学杂志,2001,20(10):774-776.
[10]Stockberger SM,Sheman S,Kopecky KK.Helical CT Cholan- geography [J].Abdom Imaging,1996,21(9):82-101.
[11]龚静山.螺旋CT胆系成像[J].国外医学临床放射学分册,1999,1:18-20
[12]Gillams A,Gardener J,Richard R,et al. Three-dimensional computed tomography cholangiography:a new technique for biliary tract imaging[J].Br J Radiol,1994,67(2):445-448.
[13]张追阳,丁乙,倪才方,等.阴性法螺旋CT胰胆管造影与直接胆胰管造影比较[J].中华放射学杂志, 2002,36(7):613-617.
[14]王耀程,魏经国,白建军,等.应用螺旋CT胆道造影诊断胆管阻塞的可靠性研究[J].实用放射学杂志,2002,18(2):84-87.
[15]Lee MG,Lee HU,Kim MH,et al. Extrahepatic biliary disease: 3D MR cholangiopancreatography computed with endoscopic retrograde cholangio gancreat ography[J]. Radiology,1997,202(3):663-669.
[16]Baron RL. Computed tomography of the bile duct (review) [J]. Semin Roentgenol,1997,32(1):172-187.
[17]梁颖,蒋涛,翟仁友,等.多层螺旋CT多平面重组技术在胆总管结石中的应用[J].中国医学影像技术,2006,22(9):1376-1377.
[18]王礼同,李澄,顾振,等.MSCT曲面重组阴性法胆管成像与MRCP对肝外胆管癌的诊断比较[J].中国医学影像技术,2007,23(8):1194-1196.
[19]贺锋,岳建国,蔡毅,等.MSCT阴性法胰胆管造影诊断低位胆管梗阻的评价[J].放射学实践2003 18(11):819-821.
[20]梁万年,王存亮(编译).如何应用四格表评估诊断试验的价值[J].中国全科医学,2005,8(2):288-289
[21]林果为.诊断试验的研究与评价[J].诊断学理论与实践.2003,2(1):附1-4.
[22]王滨有.诊断试验及其评价[J].中国地方病学杂志. 2004,23(11):630-631.
[23]Greenbreg M,Rubin JM,Greenbreg BM.Appearance of the gallbladder and biliary tree by CT cholangiography[J]. JCAT,1983,7:788-794.
[24]刘小新,郭俊渊,胡煜升.胆系造影CT对胆系疾病的诊断[J].临床放射学杂志,1995,14(1):27.
[25]Sahani D,Mehta A,Blake M,et al.Preoperative hepatic vascular evaluation with CT and MR angiography:implications for surgery [J].RadioGraphics 2004,24(5):1367-1380.
[26]Vannier MW, Marsh JL.Three-dimensional imaging ,surgical planning and image-guided therapy[J].Radiol Clin North Am,1996,34(3):545.
[27]Rydberg J,Buckwalter KA,caldemeyer KS,et al.Multi-slice CT:scanning techniques and clinical applications[J].Radiographics,2000,20:1787-1806.
[28]Park SJ,Han J K,KIM TK,et al .Three-dimensional spiral CT cholangiography with minimum intensity projection in patients with suspected obstructive biliary disease:comparison with percutaneous transhepatic cholangiography [J].Abdom Imaging,2001,26(3):281-284.
[29]张追阳,丁乙,胡春洪,等.阴性法螺旋CT胰胆管造影成像参数的研究[J].中华放射学杂志,2001,35(2):145-147.
[30]彭卫斌,陈国强,赵亮,等多.层螺旋CT胆道成像技术的临床应用[J].实用放射学杂志,2005,21(11):1166-1168.
[31]Kim HC,Park SJ,Park SI, et al. Multislice CT cholan-giography using thin-slab minimum intensity projection and multiplanar reformation in the evaluation of patients with suspected biliary obstruction Preliminary experience[J]. Radiology,2005,29(1):46-54.
[32]薛华丹,金征宇,廖泉,等.多层螺旋CT无胆道造影剂胰胆管成像[J].中国医学科学院学报.2004,26(3):268-273.
[33]王书智,陈马昊,冯敏,等.螺旋CT曲面成像在胆道梗阻疾病中的应用[J].实用医技杂志,2003,10(6):559-561.
[34]Fleischmannd,Hin GH,Schofl R,et al.Three-dimensional spiral CT cholangiography in patients with suspected obstructive biliary disease: comparison with endoscopic retrograde cholangiography[J]. Radiology,1996,198(3):861-868.
[35]Kim HC,Park SJ,Park SI, et al . Multislice CT cholan-giography using thin-slab minimum intensity projection and multiplanar reformation in the evaluation of patients with suspected biliary obstruction Preliminary experience[J]. Radiology,2005,29(1):46-54.
[36]Zeman BK,Berman PM,Silverman PM,et al. Biliary tract: three dimensional helical CT without cholangiographic contrast material[J]. Radiology,1995,196(3):865-867.
[37]张追阳,丁乙,沈袁良,等.螺旋CT胰胆管阴性成像诊断胆管高位梗阻疾病[J].临床放射学杂志,2002,21(3):210-212.
[38]杨复宾,王藏海,全冠民.正常瓦特壶腹部低张螺旋CT表现[J].中国医学影像技术,2007,23(4):575-577.
[39]孙晓伟,王霄英,邹英华,等.梗阻性黄疸患者MRCP及肝胆断层MR检查对于PTC及PTBD指导作用的分析[J].中国医学影像技术,2005,21(3):375-377.
[40]Sang Won Kim,Do Hyun Park,Hyeong Cheol Shin,et al. Duplication of the Extrahepatic Bile Duct in Association with Choledocholithiasis as Depicted by MDCT[J]. Korean J Radiol 2008;9:550-554.
[41]方义海,沈小健,黄文才.多层螺旋CT胆道成像对48例胆道病变的诊断价值分析[J].苏州大学学报(医学版) 2006,26(5):851-852.
[42]Pickuth D. Radiologic diagnosis of common bile duct stones [J]. Abdom Imaging ,2000,25(6):618-621.
[1]周宁新,黄志强.肝门胆管癌外科治疗方式的选择和预后[J].腹部外科,1993,6(3):43-45.
[2]黄志强.肝门部胆管癌外科治疗——我们要走向何方? [J].肝胆外科杂志,2003,11(5):321-322.
[3]顾军,周康荣,彭卫军,等.螺旋CT胆道造影及其三维重建的临床应用价值[J] .临床放射学杂志,2000,19(8):490-494.
[4] Stockberger SM, Wass JL, Sherman S,et al. Intravenous cholangiography with helical CT: comparion with endoscopic retrograde cholangiography [J]. Radiology, 1994,192(2):675-680.
[5]林建华,李朝龙,贺旭,等.经皮肝胆囊穿刺胆道造影与道行胰胆管造影应用价值比较[J].肝胆胰外科杂志,2000,12(4):180-181.
[6]周建华,操隆辉,陈孝岳,等.超声与CT诊断恶性肿瘤致阻塞性黄疸的价值[J].中国超声医学杂志,2003,19(10):763-765.
[7]宋光义,庞瑞麟.螺旋CT胆道成像临床应用及评价[J].(综述).云南医药, 2005,26(2):150-155.
[8] Xu AM ,Cheng HY,Jiang WB , et al . Multi - slicethree - dimensional spiral CT cholangiography: a new technique for diagnosis biliary diseasea [J]. Hepatobiliary Pancreat Dis Int ,2002,1(4):595-603.
[9]张追阳,丁乙,倪才方,等.阴性法螺旋CT胰胆管造影与直接胆胰管造影比较[J].中华放射学杂志, 2002,36(7):613-617.
[10]王耀程,魏经国,白建军,等.应用螺旋CT胆道造影诊断胆管阻塞的可靠性研究[J].实用放射学杂志,2002,18(2):84-87.
[11]陈汉,吴孟超.黄疸病人进行PTC及PTCD应注意的问题[J].实用外科杂志, 1998,8(11):570.
[12]任克,王强,徐克,等.多层螺旋CT多层面重建技术在胆道梗阻性疾病诊断中的应用[J].中国医学影像技术,2005,21(11):1720-1722.
[13]方义海,沈小健,黄文才.多层螺旋CT胆道成像对48例胆道病变的诊断价值分析[J].苏州大学学报(医学版),2006,26(5):851-852.
[14]Pickuth D.Radiologic diagnosis of common bile duct stones [J]. Abdom Imaging,2000,25(6):618-621.
[15]Cabada GT, Sarria OL, Martineez MT, et al. Helical CT cholangiography in the evaluation of the biliary tract: application to the diagnosis of choledo cholithiasis[J].Abdom Imaging,2002,27(1):61-70.
[16]王晓波,徐来喜,张锡友,等.PTC诊断梗阻性黄疸的价值(附126例报告) [J].四川解剖学杂志,1999,7(3):211-212.
[17]Vannier MW, Marsh JL. Three-dimensional imaging ,surgical planning and image-guided therapy[J]. Radiol Clin North Am,1996,34(3):545
[18]Rydberg J,Buckwalter KA,caldemeyer KS,et al. Multi-slice CT: scanning techniques and clinical applications [J]. Radiographics,2000,20:1787-1806.
[19]楼俭茹,刘文亚,温浩,等.多层螺旋CT肝脏血管成像技术的应用研究[J].新疆医科大学学报,2004,27(6):555-557.
[20]Bibao MK, Dotter CT, LEE TG,et al.Complications of endoscopic retrograde cholangiopancreatography (ERCP).A study of 10000 cases [J]. Gaste oentero logy, 1976,70(3):314-317.
[21]Vam Beers BE,Lacrosse M,Trigaux M,et al. Noninvasive imaging of biliary tree before or after laparoscopic cholecystectomy:use of three-dimensional spiral CT cholangiography [J]. ATR,1994,162(2):1331- 1335.
[22]Klein HM,Wein B,Truong S, et al. Computer tomographic cholangiography using spiral scanning and 3D image processing [J]. Br J Radiol,1993,66(9):762-767.
[23]李建生,李康印,陈虎义,等.螺旋CT胆道立体成像对胆道梗阻性疾病诊断价值的研究[J].临床放射学杂志, 2001,20(10):774-776.
[24]Gillams A,Gardener J,Richard R,et al. Three-dimensional computed tomography cholangiography: a new technique for biliary tract imaging[J]. Br J Radiol,1994,67(2):445-448.
[25]张追阳,丁乙,沈袁良,等.螺旋CT胰胆管阴性成像诊断胆管高位梗阻疾病[J].临床放射学杂志,2002,21(3):210-212.
[26]Park SJ,Han J K,Kim TK,et al . Three-dimensional spiral CT cholangiography with minimum intensity projection in patients with suspected obstructive biliary disease: comparison with percutaneous transhepatic cholangiography [J]. Abdom Imaging,2001,26(3):281-284.
[27]Kim HC,Park SJ,Park SI, et al. Multislice CT cholan-giography using thin-slab minimum intensity projection and multiplanar reformation in the evaluation of patients with suspected biliary obstruction Preliminary experience[J]. Radiology,2005,29(1):46-54.
[28]Fleischmann D , Hing H , Schofl R , et al . Three-dimensional spiral CT cholangiography in patients with suspected obstructive biliary disease: comparisonwith endoscopic retrograde cholangiography [J].Radiology, 1996,198(3):861-868.
[29]王静,刘文亚,党军.多层螺旋CT血管成像对肝癌的评价及临床应用[J].新疆医科大学学报,2008,31(2):195-196.
[30]沈小健,龚建平,蔡庆,等.多层螺旋CT胆管MPR与MRCP的初步对照研究[J].实用放射学杂志,2006,22(11):1358-1361.
[31]矫娜,孔祥泉,史河水,等.肝门部胆管癌CT与MRI的诊断价值.临床放射学杂志,2006,25(7):639-643.
[32]贺锋,岳建国,蔡毅,等.MSCT阴性法胰胆管造影诊断低位胆管梗阻的评价[J].放射学实践2003,18(11):819-821.
[33]王礼同,李澄,顾振,等.MSCT曲面重组阴性法胆管成像与MRCP对肝外胆管癌的诊断比较[J].中国医学影像技术,2007,23(8):1194-1196.
[34]周奉学,王建安,周毅.恶性梗阻性黄疸的CT征象分析(附50例报告)[J].实用放射学杂志,2004,20(7):605-607.
[35]王书智,陈马昊,冯敏,等.螺旋CT曲面成像在胆道梗阻疾病中的应用[J].实用医技杂志,2003,10(6):559-561.
[36] Hong KC, Freeny PC. Pancreaticoduodenal arcades and doseal pancreatic artery: three-dimensional volume rendering, maximum intensity projection, and shaded -surface display [J]. AJR,1999,172(4):925-931.
[37]李建生,李康印,陈虎义,等.螺旋CT胆道立体成像对胆道梗阻性疾病诊断价值的研究[J].临床放射学杂志, 2001,20(10):774-776.
[38]Raptopoulos V,Prassopoulos P,Chuttani R,et al.Multiplanar CT pancreatography and distal cholangiography with minimum intensity projections [J]. Radiology,1998,207(2):317-324.
[39]Zandrino F,Benzi L, Ferretti ML, et al. Multislice CT cholangiography without biliary contrast agent: technique and initial clinical results in the assessment of patients with biliary obstruction [J]. Euro Radiol,2002,12(5):1155-1161.
[40]熊燕,周翔平,陈宪,等.MRI、US、CT对胆道良恶性梗阻鉴别诊断的对比研究[J].实用放射学杂志,2006,22(9):1071-1074.
[41]殷信道,王利伟,卢玲铨,等.MRCP结合常规MRI诊断恶性肿瘤性胆道梗阻的临床应用[J].中国医学影像技术,2007,23(11):1670-1672.
[42]付建设,同志勤,赵京龙,等.磁共振胰胆管成像诊断胆系梗阻性疾病的临床评价[J].实用放射学杂志,2003,19(6):510-513.
[43]Mortele KJ,Ros PR. Anatomic variants of the biliary tree: MR cholangiographic findings and clinical applications [J].AJR Am J Roentgenol 2001,177(2):389–394.
[44]Hartman EM, Rartsh MA.MR cholangiography [J]. Magn Reson Imaging Clin N Am, 2001,9(4):841-855.
[45]孙晓伟,王霄英,邹英华,等.梗阻性黄疸患者MRCP及肝胆断层MR检查对于PTC及PTBD指导作用的分析[J].中国医学影像技术,2005,21(3):375-377.
[46]Leni D, Trevisan R,Vanzulli A.Imaging of donor liver transplantation [J].Radiol Med(Torino),2004,107(1-2):58-68.
[47]Limanond P,Raman SS,Ghobrial RM,et al.Preoperative imaging in adult-to-adult living related liver transplant donors:what surgerons want to know [J]. J Comput Assist Tomogr,2004,28(2):149-157.
[48]Yeh BM, Breiman RS, Taouli B, et al. Billiary tract depiction in living potential liver donors: comparison of conventional MR, mangarfodipir trisodium - enhanced excretory MR, and multi-detector row CT cholangiography-initial experience [J] . Radiology,2004,230(3):715-723.
[49]Miller GA, Yeh BM, Breiman RS, et al. Use of CT cholangiography to evaluate the biliary tract after liver transplantation: initial experience [J]. Liver Transpl,2004,10(8):1065-1068.