宝石能谱CT对胆囊炎伴早期微小穿孔的诊断价值
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摘要
目的分析宝石能谱CT对胆囊炎伴早期微小穿孔的诊断价值。方法收集我院收治的36例胆囊炎伴早期微小穿孔患者的临床资料,所有患者入院后均完成宝石能谱CT检查,先平扫,后作单能量成像,分析宝石能谱CT对胆囊炎伴早期微小穿孔的诊断价值。结果 (1)36例患者均经手术证实为胆囊炎伴微小穿孔,其中33例胆囊穿孔,3例胆总管穿孔,穿孔直径1~5 mm,平均(3.1±0.6)mm。(2)在40 ke V、140 ke V条件下,胆囊窝部与胆汁CT值差异较大,在60~80 ke V时差别较小,随ke V值上升,胆汁CT值减少,并接近负值,灰度变暗,而胆囊窝部CT值逐渐增加,且灰度增加;(3)胆囊炎伴微小穿孔患者脂/水图显示最为清晰,其胆囊窝部平均脂/水浓度、碘/水浓度均高于胆汁(P<0.05),且胆囊窝部K值高于胆汁(P<0.05)。结论宝石能谱CT单能量成像及脂/水基物质图成像可清晰显示胆囊炎伴早期微小穿孔,可将其作为胆囊炎伴微小穿孔临床诊断的有效手段。
Objective To analyze the value of gemstone spectral CT in the diagnosis of cholecystitis with early micro-perforation. Methods The clinical data of 36 cases with cholecystitis complicated with early micro-perforation in our hospital were collected. All patients completed gemstone spectral CT examination after admission. Firstly, plain scan was performed, and then the single energy imaging was performed. The value of gemstone spectral CT in the diagnosis of cholecystitis with early micro-perforation was analyzed. Results All of the 36 patients with cholecystitis complicated with micro-perforation were confirmed by surgery, including 33 cases with gallbladder perforation, 3 cases with common bile duct perforation, and the diameter of perforation was 1-5mm, with an average of(3.1±0.6) mm. Under 40 ke V and 140 ke V, the CT values of the fossa of gallbladder and bile were significantly different while under 60-80 ke V, the differences were small. With the increase of ke V value, CT values of bile decreased, close to the negative value, and the gray level was darkened. When the CT value of the fossa of gallbladder increased, the gray level increased. The lipid/water map of patients with cholecystitis and micro-perforation was the clearest, and the average lipid/water concentration and iodine/water concentration of fossa of gallbladder were higher than those of bile( P<0.05), and the K value of gallbladder was higher than that of bile(P<0.05). Conclusion The lipid/water map of gemstone spectral CT single energy imaging can clearly show cholecystitis with early micro-perforation, which can be used as an effective means for clinical diagnosis of cholecystitis with micro-perforation.
Objective To analyze the value of gemstone spectral CT in the diagnosis of cholecystitis with early micro-perforation. Methods The clinical data of 36 cases with cholecystitis complicated with early micro-perforation in our hospital were collected. All patients completed gemstone spectral CT examination after admission. Firstly, plain scan was performed, and then the single energy imaging was performed. The value of gemstone spectral CT in the diagnosis of cholecystitis with early micro-perforation was analyzed. Results All of the 36 patients with cholecystitis complicated with micro-perforation were confirmed by surgery, including 33 cases with gallbladder perforation, 3 cases with common bile duct perforation, and the diameter of perforation was 1-5mm, with an average of(3.1±0.6) mm. Under 40 ke V and 140 ke V, the CT values of the fossa of gallbladder and bile were significantly different while under 60-80 ke V, the differences were small. With the increase of ke V value, CT values of bile decreased, close to the negative value, and the gray level was darkened. When the CT value of the fossa of gallbladder increased, the gray level increased. The lipid/water map of patients with cholecystitis and micro-perforation was the clearest, and the average lipid/water concentration and iodine/water concentration of fossa of gallbladder were higher than those of bile( P<0.05), and the K value of gallbladder was higher than that of bile(P<0.05). Conclusion The lipid/water map of gemstone spectral CT single energy imaging can clearly show cholecystitis with early micro-perforation, which can be used as an effective means for clinical diagnosis of cholecystitis with micro-perforation.
引文
[1]郎宁,刘剑羽,王永进,等.多排螺旋CT鉴别诊断黄色肉芽肿性胆囊炎和胆囊癌[J].中国医学影像技术,2011,27(2):333-336.
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[6]吴晓,黄小燕,何剑,等.螺旋CT多平面重组诊断急性胆道穿孔与手术对照研究[J].放射学实践,2011,26(6):610-612.
[7]蒋昊翔,刘勃,施伟栋,等.小儿先天性胆总管囊肿自发性穿孔的CT表现[J].实用放射学杂志,2013,29(10):1646-1648.
[8]刘伟,王永兴.急性坏疽性胆囊炎40例临床分析[J].解放军医药杂志,2012,24(5):30-31.
[9]邓凯,张成琪,李伟,等.宝石能谱CT的特点及临床应用价值[J].中国医药导报,2011,8(25):16-17.
[10]艾秋宝,林云,戴鹏,等.残胃癌行胃切除术后急性坏死性胆囊炎并胆囊穿孔一例[J].中华消化外科杂志,2013,12(7):551-552.
[11]宣伟玲,赵凯宇,刘淼,等.宝石能谱CT在去除常见CT图像伪影中的应用[J].中国医疗设备,2013,28(1):157-158,43.
[12]李勇,常青,刘智军,等.超声介入联合胆道镜对急性结石性胆囊炎患者胃肠功能的影响[J].湖南师范大学学报(医学版),2016,13(5):48-50,51.
[13]赵涛,陈秋星,任传增,等.创伤或术后急性非结石性胆囊炎27例诊疗分析[J].安徽医药,2014,18(5):892-894.
[2]贾永军,贺太平.宝石能谱CT临床应用及研究进展[J].实用放射学杂志,2016,32(5):799-801.
[3]史凤霞.MSCT对黄色肉芽肿性胆囊炎的诊断价值(6例报告并文献复习)[J].中国CT和MRI杂志,2013,11(6):62-65.
[4]余红胜,沈又利,吉六舟,等.慢性胆囊炎与壁厚型胆囊癌的CT鉴别诊断[J].中国医学计算机成像杂志,2012,18(4):322-325.
[5]贺中云,方向军,田强,等.黄色肉芽肿性胆囊炎CT和病理特征[J].医学临床研究,2012,29(7):1302-1304,1309.
[6]吴晓,黄小燕,何剑,等.螺旋CT多平面重组诊断急性胆道穿孔与手术对照研究[J].放射学实践,2011,26(6):610-612.
[7]蒋昊翔,刘勃,施伟栋,等.小儿先天性胆总管囊肿自发性穿孔的CT表现[J].实用放射学杂志,2013,29(10):1646-1648.
[8]刘伟,王永兴.急性坏疽性胆囊炎40例临床分析[J].解放军医药杂志,2012,24(5):30-31.
[9]邓凯,张成琪,李伟,等.宝石能谱CT的特点及临床应用价值[J].中国医药导报,2011,8(25):16-17.
[10]艾秋宝,林云,戴鹏,等.残胃癌行胃切除术后急性坏死性胆囊炎并胆囊穿孔一例[J].中华消化外科杂志,2013,12(7):551-552.
[11]宣伟玲,赵凯宇,刘淼,等.宝石能谱CT在去除常见CT图像伪影中的应用[J].中国医疗设备,2013,28(1):157-158,43.
[12]李勇,常青,刘智军,等.超声介入联合胆道镜对急性结石性胆囊炎患者胃肠功能的影响[J].湖南师范大学学报(医学版),2016,13(5):48-50,51.
[13]赵涛,陈秋星,任传增,等.创伤或术后急性非结石性胆囊炎27例诊疗分析[J].安徽医药,2014,18(5):892-894.