Comparison of EUS, MRCP and CT in the diagnosis of stones < 4 mm in the lower segment of the bile duct
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摘要:
目的对比超声内镜（EUS）与磁共振胰胆管造影（MRCP）、CT诊断胆系结石的临床价值。 方法回顾我院于2016年1月~2018年12月收治的165例可疑性胆系结石患者临床资料，其中男77例，女88例，年龄54~71岁（47.54±5.23岁），病程1~8年（4.24±0.58年）。分别采用EUS、MRCP、CT 3种检查方法对患者进行诊断，将诊断结果与手术病理诊断结果对比，分析3种诊断方法的敏感性、特异性、准确性、阳性预测值、阴性预测值以及不同直径结石的检出率。 结果在诊断胆系结石方面，EUS与MRCP的敏感性、特异性、准确性、阳性预测值、阴性预测值跟CT检查方式相比，差异有统计学意义（P < 0.05）；EUS在胆系结石诊断方面的敏感性和准确性高于MRCP（P < 0.05）；在 < 4 mm结石中，EUS检出率高于MRCP和CT，而MRCP检出率高于CT（P < 0.05）。 结论在胆系结石的诊断中，EUS、MRCP较CT效果更好，EUS较MRCP更具优势，尤其是对胆道下段 < 4 mm的微小结石。 Abstract:ObjectiveTo compare the clinical value of of EUS, MRCP and CT in the diagnosis of chololithiasis. MethodsEUS, MRCP and CT were used to diagnose 165 patients with suspected cholelithiasis. The diagnosis results were compared with the results of pathological diagnosis. The sensitivity, specificity, accuracy, PPV, NPV and detectionrate of stones with different diameterss of three diagnostic methods were analyzed and compared. ResultsIn the diagnosis of cholelithiasis, the sensitivity, specificity, accuracy, PPV and NPV of EUS and MRCP were significantly higher than CT (P < 0.05). The sensitivity and accuracy of EUS were significantly higher than MRCP (P < 0.05). For the stones < 4 mm, the detection rate of EUS was significantly higher than MRCP and CT (P < 0.05), while the detection rate of MRCP was significantly higher than CT (P < 0.05). ConclusionsIn the diagnosis of cholelithiasis, EUS and MRCP are significantly better than CT. EUS has more advantages over MRCP, especially for stones < 4 mm in the lower segment of the bile duct. -
Key words:
- cholelithiasis /
- endoscopic ultrasonography /
- magnetic resonance cholangiography /
- CT
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图 1 胆总管下段微小结石患者
A: EUS发现胆总管末端见一高回声, 确诊为胆总管下段微小结石; B: CT未发现结石; C: MRCP未发现结石
Figure 1. Atients with small stones in the lower part of the common bile duct
表 1 3种方法诊断结果分析（%）
Table 1. Analysis of diagnosis results of three methods
诊断方法 敏感性 特异性 准确性 阳性预测值 阴性预测值 EUS 97.5% (117/120)*# 95.75% (45/47)* 96.97% (160/165)*# 98.32% (117/119)* 95.56 (43/45)* MRCP 87.5% (105/120)* 91.84% (45/49)* 88.48% (146/165)* 96.33% (105/109)* 91.11 (41/45)* CT 73.33% (88/120) 80.34% (45/56) 73.33% (121/165) 88.89 (88/99) 75.56 (34/45) *P < 0.05 vs CT; #P < 0.05 vs MRCP. 
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表 2 3种方法不同直径结石检出率比较[n (%)]
Table 2. Comparison of stone detection rate in different diameter of three methods
结石直径 EUS MRCP CT ≥8 mm (n=24） 24 (100%) 23 (95.83%) 23 (95.83%) 4~7 mm (n=52） 51 (96.15%) 49 (92.31%) 40 (73.08%)* < 4 mm (n=44） 42 (93.19%) 33 (75%)# 25 (65.82%)*
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