磁共振胆管成像和动态十二指肠液检查鉴别诊断婴儿肝炎与胆道闭锁

MR cholangiography and dynamic examination of duodenal fluid in differential diagnosis between infantile hepatitis syndrome and extrahepatic biliary atresia

目的探讨磁共振胆管成像(MRC)和十二指肠液引流对婴儿期胆道闭锁(EHBA)与婴儿肝炎综合征(IHS)的鉴别诊断价值。方法应用磁共振和婴儿十二指肠引流管对52例婴儿期持续性阻塞性黄疸行MRC和十二指肠液检查,以胆总管、肝总管显影和十二指肠液检查有胆汁(胆汁酸阳性)并经随访黄疸消退诊断为婴儿肝炎综合征;以胆总管、肝总管未显示,十二指肠液检查无胆汁(胆汁酸阴性)且经外科手术探查诊断为胆道闭锁;并将胆道闭锁MRC及十二指肠检查结果与手术、病理结果对比分析。结果52例患儿中最后有34例确诊为婴儿肝炎综合征,18例确诊为胆道闭锁。34例婴儿肝炎综合征中30例MRC能清楚显示胆总管、肝总管结构,2例显示较小胆囊,2例胆总管、肝总管未显示。首次十二指肠液检查有胆汁31例,3例无胆汁。18例胆道闭锁中13例胆囊、胆总管和肝总管未显示,4例仅显示较小胆囊,1例仅显示较大胆囊,十二指肠液检查均无胆汁。18例确诊为胆道闭锁的患儿中,17例与MRC及十二指肠引流诊断相符。结论十二指肠引流液检查能直接观察有无胆汁,诊断胆道闭锁的敏感性为100%,特异性为91.1%;MRC能显示肝外胆道结构,诊断胆道闭锁的敏感性为94.4%,特异性88.24%;十二指肠与MRC联合诊断胆道闭锁的敏感性94.4%,特异性97.06%,因此二者结合应用能较准确鉴别诊断婴儿肝炎与胆道闭锁。

Objective To evaluate the value of MR cholangiography and dynamic examination of duodenal fluid in the differential diagnosis between extrahepatic biliary atresia （EHBA） and infantile hepatitis syndrome （IHS）. Methods Fifty-two patients with cholestasis underwent MR cholangiography and duodenal fluid examination. Diagnosis of extrahepatic biliary atresia was based on nonvisualization of either common bile duct or common hepatic duct, duodenal fluid examination showed colorless and surgical exploration. Diagnosis of infantile hepatitis syndrome was confirmed with visualization of common bile and common hepatic ducts, duodenal fluid color was yellow and clinical follow-up until jaundice resolved. Results 34 of 52 infantile patients were diagnosed as IHS, 18 was diagnosed as EHBA. In 30 of the 34 patients with illS, MR cholangiography clearly depicted common hepatic and common bile ducts, in 2 patients with IHS, only smaller gallbladder was depicted, in 2 patients, common bile duct and common hepatic duct were not depicted. In 31 of the 34 patients with IHS, duodenal fluid examinations were bile acid positive. In 18 patients with EHBA, the common bile ducts and common hepatic ducts were not depicted by MR cholangiography in 13, and duodenal fluid examinations were bile negative in all 18 cases. Conclusion Sensitivity and specificity of duodenal fluid examination in diagnosis of EHBA is 100% and 91.1%. Sensitivity and specificity of MR cholangiography in diagnosis of EHBA is 94.4% and 88. 24%. Sensitivity and specificity of MR eholangiography combined with duodenal fluid examination in diagnosis of EHBA is 94.4% and 97.06%. MR cholangiography and dynamic examination of duodenal fluid are useful in the differential diagnosis between IHS and EHBA.