恶性胆管梗阻性病变的MRI及MRCP表现

MR Imaging of Malignant Biliary Obstruction

目的:探讨磁共振MR I及磁共振胰胆管成像MRCP在诊断肝内外恶性胆管阻塞性病变中的价值。方法:收集15例经手术病理和临床治疗证实的胆管恶性肿瘤病例,回顾性分析其影像学表现及与临床病理的关系。MR I检查采用T1W I和T2W I常规序列,所有病例均做MRCP扫描。结果:15例患者MR I均表现为肝内外胆管不同程度阻塞性扩张。阻塞性病变中,胆管腺癌9例,肝细胞癌4例,转移瘤2例。阻塞部位在肝门部7例,胰腺部2例,壶腹部及十二指肠乳头部6例。所有病例均经临床病理证实。结论:MR I与MRCP结合能显示胆管阻塞性扩张及阻塞部位,有较高的诊断价值。壶腹部胆管癌的直接肿块征像较少,以间接阻塞征像为主要诊断依据。

Objective To investigate the value of Magnetic Resonance（MR） imaging findings and MRCP in differential diagnosis of malignant biliary obstruction. Methods MR findings of 15 cases of carcinoma of biliary ducts confirmed surgically and pathologically were analysed retrospectively, MR Cholangio - pancreatography（MRCP） were performed in all 15 patients. Results Seven cases were intrahepatic cholangiocarcinoma. Tumor was iseintensity or mild hypointensity on T, WI and mild hyperintensity on T2WI with irregular margin;two cases were blocked in the midportion of the bile ducts and 6 cases were located in lower portion with no evident mass seen on all T1WI and T2WI, MRI and MRCP could clearly show the blocked and stenotic location. All patients showed dilation in all bile ducts. One case of dilation of extrahepatic bile ducts was caused by pancreatic head carcinoma and 2 case were metastasis of the tumor of stomach and liver. MRCP demonstrated typical ＂double duct sign＂ and abrupt interruption at periampullary adenocarcinoma in 6 cases. Conclusion MRI combined with MRCP can increase the sensitivity of diagnosis in malignant biliary obstruction, the direct sign of tumor is less seen than indirect sign when the lesion is located in distal segment of dilated common bile duct. MRI and MRCP could improve diagnosis of the tumor location.