复发性化脓性胆管炎的影像诊断

The Image Diagnosis of Recurrent Pyogenic Cholangitis

目的 分析复发性化脓性胆管炎（RPC）的影像学表现，以提高对本病的认识。资料与方法 6例中4例经手术、2例穿刺证实。6例术前1或2次超声检查，4例术前CT平扫和增强，2例术后CT平扫，6例术前均作MR平扫和磁共振胰胆管成像（MRCP），4例作动态增强扫描。结果 （1）肝内胆管病变：MRI发现肝内胆管不对称性扩张5例，伴多发性结石3例。B超显示左肝管扩张和结石4例，谝诊右肝管结石1例、误诊1例，但发现肝内胆管积气1例。（2）胆总管病变：MRI发现胆总管多发性结石2例、单发结石1例和泥沙样结石1例。B超未能显示泥沙样结石，1例胆总管下端显示不清。（3）胆囊病变：MRI显示胆囊萎缩2例，胆囊炎1例，无异常1例，胆囊切除2例。B超显示胆囊萎缩2例，胆囊炎2例，胆囊切除2例中1例残端结石。（4）肝实质病变：MRI显示肝左叶萎缩3例，胆汁性肝硬化2例，囊性扩张的肝内胆管边缘肝组织渐进性强化6例共20个病灶：单发3例，多发（4～8个）3例，分别位于肝Ⅱ段2个，Ⅲ段2个，Ⅴ段3个，Ⅶ段6个和Ⅷ段7个；扩张的胆管截面呈圆形19个、长辫子状1个，直径1．5～4．5cm；信号特点：长T1、长T2信号，并见等T1、短T2信号分隔，典型者呈“梅花瓣状”。动态增强动脉期显示囊状扩张的肝内胆管边缘轻度环形强化，门脉期中度强化，环壁增厚，静脉期和延迟期持续强化。结论 （1）肝内外胆管不规则扩张、胆系结石、胆囊炎、胆汁性肝硬化是本病的基础病变。（2）典型的影像学表现：肝内胆管多房囊性扩张并周边渐进性强化为特征，MRI平扫、增强和MRCP对本病的及时诊断具有重要意义，B超可以作为初步筛选手段。

Objective To analyze imaging findings of the recurrent pyogenie eholangitis （RPC） and make a further understanding of this disease, Materials and Methods A retrospective study was performed for 6 patients with RPC who were confirmed by surgery in 4 cases and biopsy in 2 cases. All patients had BUS, MRI and MRCP, 4 cases was performed with MR dynamic contrast enhancement, 4 cases with preeontrast and postcontrast CT scan. Results （ 1 ）Intrahepatic ducts dilated asymmetrically （ n = 5） and intrahepatic calculi （ n = 3） were found on MRI, BUS found stones and dilation of left intrahepatic ducts, but calculi of right intrahapatic duct was missed in 1 case and 1 case was misdiagnosed, but intrahepatic duct pneumatosis was found in 1 case. （2）Obstruction of common bile duct with calculi （ n = 4） was found by MRI, 2 cases with multiple stones, single stone and clay stones were found in 1 case respectively. Clay stone and lower segment of CBD could not be displayed with BUS in 1 case. （3） Atrophy and cholecystitis could be displayed in MRI and BUS. （4） Atrophy of the left lobe of liver （ n = 3）, biliary cirrhosis （ n = 2）, and ＂intrahepatic cysts＂ （ n = 6） could be found in MRI. There were 20 lesions （cyst-like dilation of intrahepatic duct） in total, 19 of which were circular shape and 1 was plait-like. Diameter was from 1.5cm to 4.5cm. Most of them were hypointensity in TjWI and hyperintensity in T1WI, septum was isointensity in TjWI and hypointensity in T2WI. In dynamic enhancement imaging, there was slight gradual enhancement and the thickness of ring wall. Conclusion （1） The basal diseases of RPC are asymmetrical dilated of intrahepatic ducts, cholelithiasis, cholecystitis and biliary cirrhosis. （2） The typical imaging features are that multiple cyst-like dilation of intrahepatie ducts with slightly gradual enhancement of surrounding parenchyma on postcontrast scan, MRI and MRCP are helpful to the diagnosis of RPC, BUS could be used as a screening technique for RPC.