CT增强结合多b值DWI对胆总管炎性狭窄与肿瘤性病变所致狭窄的鉴别诊断研究

摘要 目的：探讨计算机断层扫描（CT）增强结合多b值弥散加权成像（DWI）对胆总管炎性狭窄与肿瘤性病变所致狭窄的鉴别诊断价值。方法：回顾性分析2017年4月-2021年10月于我院经手术病理或逆行胰胆管造影（ERCP）证实为胆总管炎性或肿瘤性狭窄的106例患者的临床资料，术前均行CT增强、多b值（200、400、600、800、1000 s/mm²）DWI的磁共振成像（MRI）检查并测量其多b值DWI下的ADC值，分析胆总管炎性狭窄与肿瘤性狭窄的影像表现，比较CT增强、多b值DWI单独及结合对胆总管炎性狭窄与肿瘤性狭窄的鉴别诊断效能。结果：106例患者中胆总管炎性狭窄共43例，肿瘤性狭窄患者共63例。当b值分别为200、400、600、800、1000 s/mm²时，胆总管肿瘤性病变ADC值均显著低于胆总管炎性狭窄，差异均具统计学意义（P＜0.05），随着b值增加，其ADC值均减小。当b值分别取200、400、600、800、1000 s/mm²时，对应曲线下面积（AUC）分别为0.574、0.705、0.715、0.781、0.726，b值为800 s/mm²时诊断胆总管炎性狭窄与肿瘤性狭窄的效能最佳。CT增强结合多b值DWI对比CT增强或多b值DWI对胆总管炎性狭窄与肿瘤性狭窄的诊断效能最佳。结论：当多b值DWI取800 s/mm²时，CT增强结合多b值DWI可以显著提高胆总管炎性狭窄与肿瘤性狭窄的鉴别诊断价值，具有一定的临床应用价值。

Differential Diagnosis of Inflammatory Stenosis of Common Bile Duct and Stenosis Caused by Neoplastic Lesions by CT Enhancement Combined with Multi b-Value DWI

ABSTRACT Objective: To investigate the value of computed tomography (CT) enhancement combined with multi b-value diffusion-weighted imaging (DWI) in the differential diagnosis of common bile duct inflammatory stenosis and stenosis caused by tumor lesions. Methods: The clinical data of 106 patients with choledocholitis or neoplastic stenosis confirmed by surgical pathology or retrograde cholangiopancreatography (ERCP) in our hospital from April 2017 to October 2021 were retrospectively analyzed. CT enhancement, multi b-value (200, 400, 600, 800, 1000 s/mm2) DWI were performed before surgery, and ADC values under multi-b-value DWI were measured to analyze the imaging manifestations of inflammatory common bile duct stenosis and neoplastic stenosis. To compare the differential diagnosis of choledocholitis stricture and neoplastic stricture by CT enhancement and multi-b-value DWI alone and in combination. Results: There were 43 cases of choledochal inflammatory stenosis and 63 cases of neoplastic stenosis among 106 patients. When b values were 200, 400, 600, 800, and 1000 s/mm², the ADC values of common bile duct neoplastic lesions were significantly lower than those of common bile duct inflammatory stenosis, with statistical significance(P<0.05). With the increase of b values, the ADC values decreased. When b value was 200, 400, 600, 800, and 1000 s/mm², the corresponding area under the curve (AUC) were 0.574, 0.705, 0.715, 0.781, and 0.726 respectively. When b value was 800 s/mm², the diagnostic efficiency of inflammatory bile duct stenosis and neoplastic stenosis was the best. CT enhancement combined with multi-b-value DWI has the best diagnostic efficacy for choledocholitis stricture and neoplastic stricture. Conclusion: When multi-b-value DWI is 800 s/mm², CT enhancement combined with multi-b-value DWI can significantly improve the differential diagnosis value of choledochal inflammatory stenosis and neoplastic stenosis, which has certain clinical application value.