The Study On Application Value Of B-ultrasoundn MSCT、MR In Biliary Obstructive Disease

Objective To evaluate the diagnostic performance of B ultrasounds64-slice spiral CT and MR (MRI+MRCP) in biliary obstructive diseases helps the clinicians choose reasonable imaging methods.Materials and Methods The retrospective case-control study methods were performed in the study and the methods as follows:①Patients suspected biliary obstructive disease were underwent B ultrasound, CT, MR examinations.②Every case were evaluated by the dilatation degree of bile duct, lesion localization and the size> characteristics of lesion were described.③The surgical or ERCP results were used as the gold standard in this study.④The collected clinical data were divided into the B-ultrasond, CT and MR group. the accuracy rate of lesion position and diagnosis of each group were calculated. The paired data chi-square test was used to compare the accuracy rate among three groups.Results From October2010to October2011, a total of96patients imagings were obtained, including24cases of bile duct stones、11of cholangitis stenosis、15of chronic pancreatitis、three of congenital choledochal cyst、nine of hilar bile duct carcinoma、 six of common bile duct carcinoma、13of pancreas head carcinoma、five of ampulla carcinoma、10of gallbladder carcinoma. Confirmed by pathology or ERCP, of96cases of biliary obstructive diseases, lesions site were diagnosized correctly in83cases by ultrasound,94by CT,95by MR. The accuracy rate of the three methods were86.5%,97.9%and99.0%, respectively. Compared CT with MR,P valve was1.000,the there was not significant difference. When CT and MR were compared with B ultrasound respectively, the P values were0.001,0.000respectively,the differences were significant statistically.Of53cases of benign diseases,B-ultrasound diagnosing40cases correctly,CT diagnosing51cases correctly,Only two cases of stones missed,MR diagnosing49cases correctly,two cases of stones、1case of cholangitis stenosis、1case of chronic pancreatitis missed or misdiagnosed, The accuracies of the three methods were79.2%,96.2%,92.5%respectively.Of43cases of malignant diseases,B-ultrasound diagnosing33cases correctly,CT diagnosing42cases correctly,Only1case of gallbladder carcinoma was misdiagnosed, MR diagnosing40cases correctly,1cases of common bile duct carcinoma、1case of pancreas head carcinoma、1case of gallbladder carcinoma missed or misdiagnosed,the accuracies of the three methods were76.7%、97.7%、93.0%respectively. Of all96cases of biliary obstructive diseases,B-ultrasound diagnosing75cases correctly,CT diagnosing93cases correctly,MR diagnosing89cases correctly,the total accuracies in evaluating the nature of biliary diseases were78.1%、96.9%、92.7%respectively.Comparing CT to MR P=0.125,the difference was not significant statistically.CT and MR compared to B ultrasound respectively, the P values were0.000,0.001respectively,the differences were significant statistically.Conclusion Ultrasound was, inexpensive, non-invasive and no radiation, so it was still prefermed as screening method. CT and MR imaging have higher accuracy and can provided more information about lesion for surgical plan in the obstructive disease, so they were important methods for biliary obstructive diseases. As a result, for complicated cases, comprehensive imaging methods were recommended in clinical applications.