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Investigate the Value of CT Reconstruction of Multi-mode After T-tube Cholangiography or ERCP in the Biliary Tract Disease

Author: SunLiLi
Tutor: WangChaoZuo
School: Dalian Medical University
Course: Internal Medicine
Keywords: Biliary obstruction ERCP T tube cholangiography Multislice spiral CT CT multi-mode reconstruction
CLC: R657.4
Type: Master's thesis
Year: 2011
Downloads: 5
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Abstract


purposes:To compare Endoscopic Retrograde Cholangio-Pancreato graphy or T tube cholangiography with the image of CT reconstruction of multi-mode after T—tube cholangiography or ERCP (including multi-planar reconstruction, surface reconstruction and maximum intensity projection).Statistic the accurate rate of localization and qualitative diagnosis in two methods of the biliary obstruction diseases.To evaluate the clinical applications of post-ERCP or T tube cholangiography spiral CT scan reconstruction of the joint multi-mode technology.Materials and Methods: In this article,67cases (ERCP32 cases, T control 35 cases )were selected from June 2010 to April 2011, Dalian Central Hospital, during the line of T tube cholangiography or ERCP.All of patients(42 males and 25 female) ranged from 46 to 91 years (mean 68.3 years).After complete of preoperative preparation in the patients of this group,inject 25% of diatrizoate 40ml into the bile duct , to observe the whole process of injection by two diagnosed doctors in X-ray, multi-angle radiography after observing (all by philips omni DIAGNOST gastrointestinal X ray machine), reading immediately after radiography films and scanning by Hitachi (HITACHI) ECLOS 16 upper abdominal spiral CT, scan parameters: tube voltage ball 120KV, current 200mA, reconstruction slice thickness 4mm, pitch 0.65×16, spacing 3mm. Patient supine, breath-hold scan 10-20S, ranging from every 2 under the 2CM to the lower edge of lumbar body, including the entire hepatobiliary system, duodenal ampulla and head of the pancreas. Then its 0.625mm axial source images (ASI) reached AW.44 post-processing workstation line reconstruction, including multi-planar reconstruction (MPR), surface reconstruction (CPR) and maximum intensity projection (MIP). pathological results have been obtained in all patients in this group with ERCP and some patients with T tube cholangiography. All of patients who has been in T tube cholangiography or ERCP to be CT scan were reconstructed through multi-mode technology ,and then MPR、CPR、MIP were performed.meanwhile compared with X-ray images.The qualitative diagnosis of radiopaque calculi of bile duct and bubble images can be diagnosed by CT, except for radiopaque calculi and bubble images,The qualitative diagnosis of other negative shadows using surgery or pathologic diagnosis as the gold standard of final diagnosis . Statistical analysis was executed by SPSS 16.0 software, Two diagnostic methods compared using chi-square test.Results:1.There are no obvious difference for position identifying of obstruction of bile duct between X-ray Cholangiography and CT joint MPR, CPR, MIP.The accurate rate of localization diagnosis was 100%.2.The Qualitative diagnostic accuracy of X-ray Cholangiography in this group of cases was 62.7%, the Qualitative diagnostic accuracy of CT reconstruction of multi-mode after T—tube cholangiography or ERCP was 85.1%. The Qualitative diagnostic accuracy of X-ray Cholangiography to cholelithiasis was72.4%, the Qualitative diagnostic accuracy of CT reconstruction of multi-mode after T—tube cholangiography or ERCP to cholelithiasis was79.3%; the Qualitative diagnostic accuracy of X-ray Cholangiography to inflammatory biliary stricture was77.8%, the Qualitative diagnostic accuracy of CT reconstruction of multi-mode after T—tube cholangiography or ERCP to inflammatory biliary stricture was100%; the Qualitative diagnostic accuracy of X-ray Cholangiography to Malignant biliary obstructionwas60.8%, the Qualitative diagnostic accuracy of CT reconstruction of multi-mode after T—tube cholangiography or ERCP to Malignant biliary obstructionwas82.6%.3.For the Qualitative diagnostic accuracy in malignant and benign lesions of bile duct, CT reconstruction of multi-mode after T—tube cholangiography or ERCP was higher than the X-ray image significantly, the difference between two methods was statistically significant (P <0.05).Conclusion:1.CT reconstruction of multi-mode after T—tube cholangiography or ERCP is a rapid,noninvasive and convenient diagnostic tool.It is important on the diagnosis of biliary obstruction . 2.CT reconstruction technique of multi-mode after T—tube cholangiography or ERCP can show the three-dimensional anatomical structure, to identify the site of bile duct lesions, shape, scope, nature and the relationship with the surrounding tissue clearly. the use of CT reconstruction technique of multi-mode after T—tube cholangiography or ERCP can improve the accuracy of disease diagnosis,especially to for X-ray imaging failed to clear the lesions in Biliary obstruction.3.In addition to providing information about the biliary system, CT reconstruction technique of multi-mode after T—tube cholangiography or ERCP but also to provide information outside the biliary tract, it is provide more comprehensive and more effective diagnostic information in bile duct obstruction

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CLC: > Medicine, health > Surgery > Of surgery > Abdominal surgery > Gallbladder, bile duct
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