The Value Of MSCT And Target Scan In The Etiological Diagnosis Of Bile Duct Obstruction

ObjectiveThe purpose of this project is to investigate the appropriate value of MSCT and target scan in the etiological diagnosis of common bile duct obstruction, to analyze the CT radiological characteristics of each disease, differentiate benign from malignant obstruction, and identify the lesions origin from different organization structures, in order to provide an accurate clinical treatment information.Materials and methodsTo analysis 69 patients with obstructive jaundice, who followed CT examination and confirmed by surgical pathology or clinical diagnosis in our hospital. Conventional gastrointestinal tract prepared, in first, all the cases used GE Light Speed 64-slice spiral CT scanning and Ulrich Medical Injector underwent abdominal CT, then underwent target scan according to the biliary obstructive location of the former images. The center of scan is common bile duct obstruction area, at last the three-stage contrast material-enhanced abdominal CT. The images were delivered to GE AW4.3 workstation for various reconstruction and measurement processing. To compared the characteristics of various techniques according to the signs of disease. All patients were divided into benign and malignant obstruction according to the nature of lesions. Combined with surgical pathology or clinical diagnosis, we analysis of several aspects: the coincidence rate of the locational and qualitative diagnostic accuracy, the feature of soft tissue mass, the obstruction patterns of common bile duct, the enhancement of lesion, the dilated extent of common bile duct and the pancreatic duct. Then using SPSS16.0 to apply and analyse the relevant statistical data, the methods were used such asχ2 test, and P =0.05 was set as significant.Results1)In 69 obstruction cases, conventional CT scan and target scan showed lesions were all 53 cases. In the conventional CT, the lesions density of uniform and uneven were respectively 29, 24 cases; and the target scans were 27, 26 cases. P> 0.05, no significant differences. In the conventional CT, the lesions outline and border of clearly and less clear were respectively 36, 17 cases; in target scan were respectively 47, 6 cases. P<0.05, target scan showed lesions more clearly than the conventional CT.2)Among 69 patients, CT axial images showed lesions in 53 cases, suspicious lesions 16 cases, axial and reconstruction images were respectively 59, 10 cases. There was no difference.3)Among 69 patients, CT enhanced axial images showed lesions in 59 cases, suspicious lesions 10 cases, enhanced axial and reconstruction images were 67, 2 cases. P<0.05, enhanced axial and reconstruction images shows the probability of disease was significantly higher than enhanced axial images.4)Of benign bile duct obstruction in cases of the localizing accuracy and qualitative accuracy were respectively 100%(31/31), 93.5%(29/31); and of malignant were respectively 100%(38/38), 97.4%(37/38). There was no significant difference in qualitative accuracy between benign and malignant bile duct obstruction , P> 0.05.5)Among 69 patients,16 cases were bile duct cancer, and 15 cases were diagnosed precisely, 1 case misdiagnosed as inflammation; three cases of duodenitis with glandular hyperplasia, 1 case was considered as ampullaris carcinoma but not except for glandular hyperplasia ,and another 2 cases misdiagnosed as ampullary carcinoma; 12 cases of ampullary carcinoma, 6 cases of pancreatic head carcinoma, 1 case of hilar bile duct cancer and choledocholith, 19 cases of common bile duct calculus, 8 cases of cholangiolitis, 1 case of common bile duct was infiltrated by recurrent adenocarcinoma of the duodenum, 2 cases by metastasis lymph node from the retroperitoneal, and one case of congenital biliary dilatation, and the above mentioned had made the correct diagnosis. Besides, the infiltrated form of common bile duct appears as nodular changes in 23 cases, circular or semi-circular changes in 10 cases, and cauliflower changes in 8 cases. Vascular was infiltrated in 3 cases, intrahepatic metastasis in 1 case, hilar lymph node metastasis in 1 case, peripancreatic and retroperitoneal lymph node metastasis in 5 cases.6)The display of soft-tissue mass between benign and malignant bile duct obstruction were respectively 3, 36 cases. Compared the two groups, P<0.05, the malignant groups showed soft-tissue mass was significantly higher than the patients with benign obstruction.7)The cases of sudden obstruction and progressive obstruction in the benign were respectively 23, 8; and in the malignant were respectively 35, 3. There was no significant difference in the two groups, P> 0.05.8)Slight and severe dilated in common bile duct for benign obstruction was respectively 8, 23; and for the malignant was respectively 11, 27. There was no significant difference between the two groups, P>0.05.9)The number of patients who showed"double pipe sign"between benign and malignant obstruction was respectively 4, 16."Double pipe sign"in cases of malig- nant obstruction was significantly higher than cases of benign obstruction, P<0.05.Conclusion:MSCT and target scan could clearly show the radiological characteristics of the common bile duct obstruction. It was beneficial for etiological diagnosis and differentiating benign from malignant obstruction, and was significant to enact treatment protocols and assess the prognosis. Accordingly, it was an effective method for the diagnosis of disease.