肝外胆管癌常规磁共振和磁共振胆胰管造影的诊断价值

MR cholangiopancreatography and MR imaging in the diagnosis of extrahepatic cho langiocarcinoma

目的 探讨肝外胆管癌的常规磁共振 (MRI)和磁共振胆胰管造影 (MRCP)影像表现和临床应用价值。方法 5 4例经手术病理证实的肝外胆管癌经常规MRI检查 ,其中MRCP 4 4例 ,Gd DTPA增强扫描 2 9例。综合分析MRI和MRCP的影像学表现和诊断 ,并与手术病理结果进行对照。结果MRI显示肿块 39例 ,2 9例增强扫描中 2 2例病灶强化 ,胆管壁不规则增厚 13例。MRCP显示病变部位胆管中断 ,梗阻近端形态截断状或圆锥状 16例 ,鸟嘴状或鼠尾状 2 6例 ,杯口状 2例。 2 9例显示梗阻远端的胆管。结合常规MRI和MRCP原始与重建图像 ,定位诊断准确率为 96 .3% ,定性诊断准确率为92 .6 %。结论 常规MRI和MRCP源像是MRCP诊断肝外胆管癌的重要补充。MRCP结合常规MRI对肝外胆管癌定位诊断准确 ,定性诊断有较高特异性。

Objective To evaluate the imaging features of MR Imaging (MRI) an d MR cholangiopancreatography (MRCP) and their clinical value in the diagnosis o f extrahepatic cholangiocarcinoma. Methods MRI was performed in 54 patients wi th extrahepatic cholangiocarcinoma proved surgically and pathologically,MRCP in 44 patients,Gadolinium-enhanced in 29 patients. MRI,MRCP and pathological fi ndings were analyzed retrospectively. Results By MRI,the mass was shown ( n =39) and all bile duct thickened ( n =13) in extrahepatic cholangiocarcinoma. Gado lini um-enhanced ones revealed calcified focus ( n =22). By MRCP,interrupted,abr uptly cut-off or cone-like changes of the bile duct ( n =16),beak-like or mouse tail c hanges ( n =26) or tumbler mouth appearance ( n =2) were shown. The bile duc t distal to the obstruction was observed in 29 patients. Of the 54 patients examined by MRI in combination with MRCP,correct tumor localization was made in 52(96.3%) a nd correct judgement of tumor nature in 50 (92.6%). Conclusion Conventional MRI is an effective supplement to MRCP in the diagn osis of extrahepatic cholangiocarcinoma. MRCP combined with MRI is able to signi ficantly improve the diagnostic accuracy of MR examination.