MRCP结合常规MRI诊断恶性肿瘤性胆道梗阻的临床应用

Clinical application of combining MRCP and routine MRI in diagniosing biliary tract obstruction with malignant tumors

目的研究MRCP结合MRI对胆道梗阻恶性肿瘤的诊断价值。方法46例胆道梗阻恶性肿瘤患者,常规T1WI、T2WI及脂肪抑制T2WI检查后,行MRCP检查。分析不同部位胆管梗阻恶性肿瘤的MRI、MRCP表现,与病理诊断对照。结果46例患者,4例MRCP仅肝内胆管扩张,肿块T2WI高信号,病理诊断肝内胆管细胞癌;10例MRCP肝门"空虚征"、肝内胆管枯树枝状扩张,肿块T2WI高信号7例,病理诊断胆管癌6例,胆囊癌4例;32例胆总管截断或狭窄,近段胆管、肝内胆管扩张,肿块T2WI稍高信号14例,病理诊断胆管癌12例、胆囊癌3例、胰头癌6例、壶腹癌5例、十二指肠腺癌及乳头腺癌6例。结论常规MRI和MRCP联合应用有利于恶性肿瘤性胆道梗阻的定位、定性诊断。

Objective To investigate the value of conventional magnetic resonance imaging（MRI）and magnetic resonance cholangiopancreatography（MRCP）in diagnosing biliary tract obstruction with malignant tumor as well as compare to its pathology.Methods Forty-six cases were included in this study,MRCP were performed following T1WI,T2WI and Fat-Saturation T2WI in each case.Conventional MRI and MRCP appearances of dilatation of bile duct in different locations were compared to its pathology.Results In 46 cases,4 cases can be observed hyperintensive signals on T2WI and intrahepatic bile tract dilation on MRCP with cholangiocarcinoma from intrahepatic bile duct in pathology;10 cases can be shown hilar defect-sign with approximal bile tract dilation on MRCP in all cases and 7 cases of which hyperintensive signals on T2WI.Their pathological diagnosis were extrahepatic bile duct carcinomas（6 cases）and gallbladder carcinomas（4 cases）.Thirty-two cases can be observed common bile break-off or stenosis on MRCP and 14 cases of which slight hyperintensive signals on T2WI.Their pathological diagnosis were extrahepatic bile duct carcinoma（12 cases）and gallbladder carcinomas（3 cases）and pancreatic head carcinoma（6 cases）and carcinoma of Vater＇s ampulla（5 cases）and ampullary adenocarcinoma or adenocarcinoma of the duodenum（6 cases）.Conclusion Combination MRI and MRCP can help for the diagnosis of the nature and location of biliary tract obstruction with malignant tumor.