Diagnosis Of Biliary Tract Obstructive Diseases By Multislice CT Cholangiography After Low Tension And Drinking Water: Clinical Study

Background Biliary tract obstructive diseases is one of clinical common diseases, theclinical symptoms take jaundice and abdominal pain as the principal thing, and thesymptom may more serious. There are different kinds of imaging examination method forchoice. The Commonly used traumatic methods for percutaneous transhepaticcholangiography, endoscopic retrograde cholangiopancreatography and intrave-nouscholangiography, the check for noninvasive method is X-ray gallbladder imaging,ultrasound, multislice CT cholangiopancreatography and magnetic resonancecholangiopancreatography. It has its own advantages and disadvantages for the method,the doctor can choose it according to the actual situation. At present, because of its lowprice, check the convenient, information, indications wide, MSCT become the importantinspection method in the biliary disease, It includes Spiral CT Cholangiography（SCTC）and negative MSCT Cholangiography （N-CTC）. SCTC need intravenously or oralbiliary contrast material, and CT scans in contrast material are filled with the biliary tract,using the high density contrast with positive biliary and low density around theorganization of the density difference, we can get biliary imaging. But serum bilirubinlevel can affect SCTC, it needs a long time to prepare, so now less application. N-CTC isa non-invasive diagnosis of biliary imaging technology and developed rapidly in recentyears, its principle that intravenous non-ionic iodine contrast agents, it strengthen thepancreas, liver, bile duct walls and other essential organs, but don’t strengthen biliary, sothat biliary system presents relative low density and imaging. At present N-CTC biliaryobstruction of disease diagnosis value gradually get approval. In this study the method isbased on N-CTC, in preparation for the work requirements in different period of patients with drinking lots of water, so filling the duodenum circle, coxal muscle away spininjection Raceanisodamine hydrochloride injection (654-2) in the scanning15minutesbefore, to duodenal circle and pot of abdominal muscle relaxation, fully displayed the bileduct expansion, so it can give as much diagnosis information, and achieve the purpose ofconvenient diagnosis.CT examination in diagnosis of diseases biliopancreatic obstruction in a veryimportant significance, and in the qualitative, orientation, preoperative stage, theoperation ways of choice has an important role. How to reasonable and effective use ofCT examination, is the necessary tasks for clinical and radiographic doctor. At present, the64row (128layer) spiral CT we used, with quickly scan and high rate of coverage perunit time and acquisition of more information and less image artifacts, more thin scanningand a thick layer of reconstruction, thick layer of0.625mm, and with powerful3Dpost-processing technology, it can achieve isotropic requirements. At present the workstation to provide the multi planner-reconstruction(MPR), curved planarreformation(CPR), volume rendering(VR) and minimum density projection (MinIP)reconstruction technique. The application of these technologies, change the traditional CTto observe as an axial model, provides a solid and perspectives, observe the lesion way, tobiliary disorders of early diagnosis, differential diagnosis and positioning, qualitativediagnosis is a great help. The first part of this study collect cases with biliary obstructiondisease for multislice CT Cholangiography after low tension and drinking wateror thecommon MSCT, in the positioning, qualitative aspects to control study, the second part ofcomparative analysis to the MPR, CPR, MinIP in the application of diseasebiliopancreatic obstruction. The third part analysis the characteristic of benign andmalignant by multislice CT Cholangiography after low tension and drinking water,and research biliopancreatic obstruction of CT disease diagnosis and differential diagnosis.The fourth part to analysis the patients material who with MSCT and MRCP, to comparethe location accuracy and qualitative accuracy of MRCP and MSCT. Part one Effects of multislice CT cholangiography after low tension anddrinking water on diagnosis of biliary tract obstructive diseasesObjective To explore the value of the multislice CT(MSCT) after low tension anddrinking water in the diagnosis of biliary tract obstruction diseases. Methods140casesof obstructive jaundice patients, Random into low tension group and conventional group,A group of70patients with multislice CT cholangiography after low tension anddrinking water. Conventional group of70patients with conventional MSCT biliaryimaging. Two groups of imaging results contrast pathological or ERCP results,comparison the differences between the two groups in the positioning, qualitativediagnosis. Results In the third paragraph of the positioning accuracy of biliary lowtension group higher than conventional group（χ2=4.09,P<0.05）. In malignant tumor ofaccuracy qualitative low tension group higher than conventional group （χ2=6.73,P<0.01）. Conclusion The technology of multislice CT cholangiography after lowtension and drinking water have certain advantages, on the diagnosis of the low post andformalignant biliary obstruction of diseases.Part two3D reconstruction technique of the application in multislice CTcholangiography after low tension and drinking water. Objective Compare theapplication value of three kind of3D reconstruction technique in biliopancreaticobstruction to disease. Methods3D reconstruction method which is MPR, CPR andMinIP, we analyzed three kind of3D reconstruction technique in the clinical applicationof biliopancreatic obstruction. Results Three kind of image quality rank and inspectionresults between no obvious difference. At meet the requirements in the diagnosis of rankand score that test result was statistically different. MPR is the highest accuracy in threekinds of reconstruction, in a separate qualitative and positioning diagnosis diagnosis.Conclusion MPR have higher application value in the biliary obstruction disease, the reasonable choice and use of3d reconstruction technique, is the good added axis bitimage, and can provide more diagnostic value.Part three Benign and malignant disease biliopancreatic obstruction performanceanalysis of MSCT after low tension and drinking water. Objective To analyzebiliary benign and malignant disease performance of MSCT after low tension anddrinking water. Explore the value of MSCT after low tension and drinking water to biliarydisorders of the diagnosis. Methods Statistical analysis of70patients of expansion form,degree of bravery and the obstruction of the parts and forms. Results The expansiondegree of intrahepatic bile duct between the two groups were not significant, braverymanager is outspread degree between the two groups are statistically significant,intrahepatic bile duct expansion between the two groups form with a statisticalsignificance, the obstruction of the shape, site between the two groups have statisticalsignificance. In dynamic strengthened, because of different kinds of the pathology,malignant tumors behave differently. Conclusion Comparative analysis to the benignand malignant disease imaging modality of biliopancreatic obstruction, can improve theaccuracy of MSCT diagnosis.Part four Comparative study of MSCT after low tension and drinking water andMRCP Objective Compare the application value of MSCT after low tension anddrinking water and MRCP in biliopancreatic obstruction to disease. Methods Contrastanalysis of30cases of biliopancreatic obstruction of the disease patients positioning andqualitative accuracy of MSCT after low tension and drinking water and MRCP. ResultsThe two checking method of qualitative and location accuracy no significant differences.Conclusion MSCT after low tension and drinking water is a good alternative andcomplementary inspection methods for MRCP.