Experimental And Clinical Study On The Imaging Of Biliary Disease

Objective:1、To explore the application value of in vitro models of biliary disease incomparison imaging study;2、To explore the diagnostic of64-spile CT, ultrasound,MRI with MRCP, ERCP in the in vitro models of biliary disease.Methods:1. Six plastic pipes with known diameter(diameter were3mm、6mm、8mm、10mm、12mm、16mm) replaced bile ducts. We injected the model bile (which was1:400diluted solution of diatrizoate) as the native bile, closed the both ends of thepipes, and then got the image from64-slice CT, ultrasound, MRI with MRCP, X-rays.The diameters in the experiment were measured and compared with the true ones.2.15analog bile duct were divided into3groups (diameters of each group were6mm,8mm,10mm,12mm,16mm), and0-9pieces of stones of different sizes wererandomly put into the bile ducts (total72pieces). Both ends of the bile duct wereclosed, after being washed by physiological saline, being sunk in formalin, and beinginjected model bile into. Images were produced by using various imaging methods.the sizes of stones were measured and compared with the actual measurement.3.0-6pieces of stones of different sizes (total74pieces) were put into the simulatedvitro pig gallbladders filled with model bile. Using No.3.5surgery line to tie themouth of the simulated gallbladders, we got images from various imaging methods.The sizes of the stones were measured and compared with the actual measurement.4. We opened the simulated gallbladders, tied nodules in the gallbladder wall with No.3.5surgery lines to simulate polyps, and then got images from various imagingmethods.The sizes of polyps were measure, and compared with the actual measurement. The experimental data were analyzed with statistics software ofSPSS16.0.Results:1. The results of measurement on every imaging method were closer to the actualdiameters. There was significant difference in comparison of various examinationmethods. When compared the examination with the actual diameters, only64-slice CThad no significant difference (P>0.05), and other tests had significant differences(P<0.05).2. The accuracy of simulated bile duct stones for64-slice CT, ultrasound, MRI withMRCP, X-rays were:93.3%,73.3%,86.7%, and100%.3. The accuracy of simulated gallstones for64-slice CT, ultrasound, MRI with MRCP,X-rays were:80%,90%,65%, and70%.4. The accuracy of simulated gallbladder polyps for64-slice CT, ultrasound, MRIwith MRCP, X-rays were:65%,80%,50%, and60%.5. In comparison with the rates of different imaging methods among different sizesbile duct stones, gallbladder stones, gallbladder polyps: the group with diametersbetween5mm and10mm, and in the group of diameters<10mm, the difference ofthe statics was significant(P<0.05); in the group of diameters>10mm, the difference ofthe statics was not significant(P>0.05).Conclusion:1. In vitro models for biliary disease can be used to compare the value of imagingdiagnosis;2. For the measurement of bile duct diameter, the value of64-slice CT is higher thanultrasound, MRCP and X-rays. For the accuracy of locating the lesions and qualitativein diagnosing obstructive jaundice, the value of64-slice CT with MPR, CPR is higherthan convention transverse and other examinations. Part Ⅱ Clinical researchObjective: To explore the diagnostic value of64-spile CT, ultrasound, MRI withMRCP, ERCP in the diagnosis of biliary disease.Methods: Eighty six cases of gallbladder stones, gallbladder polyps, obstructivejaundice that had been highly suspected in clinical signs were collected, and wereexamined by every imaging methods. Then the image results were compared with theresults of surgery and pathology, or ECT lithotomy, PTCD. According different diseases, theindication ratio of various methods was calculated and compared. The experimental datawas analyzed with statistics software of SPSS16.0.Results:1. The accuracy of biliary disease for64-slice CT, ultrasound, MRI with MRCP,ERCP were67.4%,65.1%,65.1%,90%. The accuracy of ERCP in biliary diseasewas higher than other methods (P<0.05). The accuracy of64-slice CT, ultrasound,MRI with MRCP were compared was no significant difference（P>0.05）.2. The value of64-slice CT with MPR, CPR was higher than convention transverse inthe diagnosis of obstructive jaundice. There were significant differences (P<0.05).3. Among these examinations in the accuracy of locating the lesions and qualitativediagnosis for obstructive jaundice, ERCP had the highest accuracy rate (100%,90%),and ultrasound was the lowest (78.3%,58.3%). The accuracy rate for ERCP washigher than ultrasound and MRCP (P<0.05), and CT was higher than ultrasound(P<0.05), while the accuracy rate between CT and ERCP, CT and MRCP, ultrasoundand MRCP had no significant difference (P>0.05).Conclusion:1. In the comparative diagnostic imageology for biliary disease, ultrasound has a goodsensitivity and accuracy, especially in gallbladder stones and polyploid lesions.2. There are no obvious difference for position identifying of obstructive jaundiceamong MRCP+MRI,64-slice spiral CT, and ERCP; the diagnosis in qualitation ofobstructive jaundice, the former is worse than the latter two.3. ERCP can’t be replaced by others, in the light of its important value in the diagnosis of obstruction of bile duct.