磁共振胰胆管成像对梗阻性黄疸的定性研究

Value of MRCP in the diagnosis of the biliary obstructive diseases

目的:探讨磁共振胰胆管成像(MRCP)对胆道梗阻性疾病的诊断价值。方法:使用1.5T磁共振扫描仪,对489例可疑胆管梗阻性疾病及正常人行MRCP检查,原始图像作三维重建,然后分析其影像表现及诊断结果。结果:MR-CP能清晰显示胰胆管的解剖结构,对胆道梗阻程度和梗阻部位判断的确诊率达100%。恶性梗阻的胆管扩张程度较良性梗阻重。结合MRCP原始图像和常规MRI能明确显示肿瘤大小及范围。MRCP鉴别良恶性梗阻的敏感性为92%,特异性为97%,准确性为95%。结论:MRCP检查的成功率高,胰胆管解剖结构显示清晰,适用于各种胰胆管疾病的诊断,可为恶性胰胆肿瘤术前可切除性提供评价,可作为该系统疾病诊断的首选方法。

Objective: To evaluate the clinical application value of MR cholangiopancreatography (MRCP) in the diagnosis of biliary obstruction. Methods: MRCP was performed in 489 cases, including 162 normal control group and 327 patients with various pancreaticobiliary duct disease. Advanced fast spin-echo(FASE) was used for heavily T2-weighted and maximum intensity projection(MIP) algorithm was made for three-dimensional(3D) reconstruction on workstation. The findings of MRCP images were analyzed. Results: MRCP can exhibit the structure of pancreaticobiliary duct. The accuracy of MRCP in detection of the degree and location of bile duct obstruction was 100%. The degree of bile duct dilation in malignant obstructions were more serious than that in benign ones. The source images and conventional MRI were helpful to define the tumors' margin and extent. The sensitivity, specificity and accuracy of MRCP were 92%, 97% and 95% respectively in detecting benign and malignant obstructions. Conclusion: MRCP examination has a high success rate and can demonstrate pancreaticobiliary duct diseases. It can help make a preoperative assessment for the potential of resection. MRCP may provide an efficient alternative to direct cholangiopancreatography.