磁共振3D-VIBE序列联合MRCP在肝门部胆管癌T1期中的诊断价值

The Diagnostic value of MRI VIBE Sequence Combined with MRCP in T_1-staging Hilar Cholangiocarcinoma

目的探讨磁共振三维容积式内插法屏气检查序列(3D-VIBE)联合磁共振胆胰管成像(MRCP)在肝门部胆管癌T1期中的诊断价值。资料与方法回顾性分析经手术病理证实的T1期肝门胆管癌16例,术前均经MR3D-VIBE三期增强扫描和MRCP检查,复习MR肝门部胆管癌T1期3D-VIBE三期增强扫描和MRCP的影像学表现并与手术病理作对照。结果16例T1期肝门部胆管癌中,单纯发生于肝管汇合部7例;同时侵及左肝管4例,侵及右肝管2例;肝管汇合部未见病灶,仅发生于左肝管2例,右肝管1例。肿瘤呈结节状3例,结节合并浸润状2例,单纯浸润状11例;局部淋巴结增大5例,胆囊萎缩2例。MRIT1WI平扫呈等信号4例,稍低信号12例,T2WI呈等信号2例,稍高信号14例;MRCP表现为肝门部胆管截断3例,其上肝内外胆管呈"软藤样"扩张;肝门部胆管狭窄、变细4例,狭窄呈"鼠尾状"或"矛尖状",肝左右叶扩张的胆管在肝门部不能汇合;肝外二级胆管狭窄9例,狭窄段以上胆管不同程度扩张。3D-VIBE三期增强扫描动脉早期肿瘤轻度强化,动脉晚期和门静脉期中到明显强化。结论MR3D-VIBE联合MRCP检查能够提高T1期肝门部胆管癌的检出率。有助于指导临床术前制定合理的手术方案。

Objective To explore the diagnostic value of MR 3D-VIBE sequence combined with MRCP in T1 staging hilar cholangiocarcinoma. Materials and Methods 16 cases with T1-staging cholangiocarcinoma confirmed by surgery and pathology were retrospectively analyzed. Gadolinium enhanced dynamic VIBE multiphasic scan and MRCP were performed before operation. Imaging findings were reviewed and compared with surgical and pathological results. Results Among the 16 cases with T1 staging hilar cholangiocarcinoma,solitary genesis in the junction of hepatic duct occurred in 7 cases, left hepatic duct was simultaneously invaded in 4 cases, and the fight hepatic duct in 2 cases, lesions couldnt be found in the junction of hepatic duct, but generate in the left hepatic duct for 2 cases and in the right hepatic duct for 1 case. The tumor-like nedosity occurred in 3 cases, nedosity complicated with infiltration in 2 cases and simple infiltration in 11 cases. Partial lymphadenovarix occurred in 5 cases, and gallbladder was atrophied in 2 cases. On MRI plain scan, T1WI isointensity signal occurred in 4 cases and slightly T1 WI hypointensity signal in 12 cases, T2WI isointensity signal presented in 2 cases and slightly T2WI hyperintensity signal in 14 cases; the findings of MRCP included cut sign of hilar cholangiocarcinoma in 3 cases, superior hepatic duct of which presented cholangiectasis liking soft vine. Stenosis and thinning of hilar bile duct occurred in 9 cases and the sign of stenosis presented rat tail or spare sharp appearance, then intrahepatic bile duct couldnt converge in the hepatic hilum; the second class extrahepatic bile duct presented stenosis in 9 cases, and the superior bile duct presented broaden in different degree. Gadolinium enhanced 3D-VIBE mutiphasic acquisition presented slightly enhanced on early arterial phase and moderate to marked enhancement on advanced arterial phase and portal venous phase. Conclusions MR 3D VIBE sequence combined with MRCP is able to improve detection rate of T1 staging hilar cholangiocarcinoma and is helpful for guiding clinician to make reasonable operating program before operation.