低张MRCP结合Propeller LAVA动态增强扫描在壶腹周围病变中的应用价值研究

Study of hypotonic-MRCP combined with Propeller LAVA enhancement scanning in the diagnosis of periampullary diseases

目的:探讨低张胰胆管水成像(magnetic resonance cholangiopancreatography,MRCP)结合Pro-pellerLAVA多期动态增强扫描在壶腹周围病变综合诊断中的临床应用价值。方法:对34例壶腹周围病变患者在常规MR扫描基础上行低张MRCP及十二指肠低张后PropellerLAVA多期动态增强扫描,对原始图像进行3DMIP及MPR重建后处理,观察病变的间接及直接征象并与临床随访及病理结果对照。结果:34例中31例梗阻性质诊断明确,1例胰头癌漏诊,2例炎症误诊为肿瘤,定性诊断准确率为91.2%。30例行PropellerLAVA增强扫描,直接征象显示率达93.3%,肿瘤浸润范围诊断符合率为80.8%。26例肿瘤性病变中壶腹部癌5例,胆总管远端癌11例、胰头癌9例、壶腹周围十二指肠腺癌1例,定位准确率分别为88.5%(23/26)、84.6%(22/26)、88.5%(23/26),十二指肠腺癌误诊为乳头癌。另外直观显示了4例病变局限、直径在2.0cm以内的早期壶腹周围癌。结论:低张MRCP结合PropellerLAVA动态增强扫描能够全面、直观显示壶腹部病变的间接及直接征象,在明确肿瘤性病变的范围及周围组织、血管浸润方面具有重要意义,对壶腹部较小或隐匿病变亦具有较高的应用价值。

Obiective： To discuss the value of hypotonic-MRCP combined with Propeller LAVA dynamic multi-phase enhancement scanning in the synthetic diagnosis of periampullary diseases. Methods： Thirty-four patients with periampullary diseases underwent MRI exami- nation after duodenum was in hypotonicity, and then examined with hypotonic-MRCP and Propeller LAVA dynamic multi-phase enhancement scanning. The original images was reformed by MIP and MPR. The direct and indirect signs were observed and compared with the clinical and pathologic results. Results： In 34 cases, 31 cases were clearly diagnosed, 1 carcinoma of pancreas head was missed, 2 inflammations were misdiagnosed as tumor. Thirty cases underwent Propeller LAVA dynamic multi-phase enhancement scanning, the direct sign rate was 93.3% and the extension diagnose rate was 80.8%. In 26 tumor cases, there were 5 ampullary carcinomas, 11 cholangiocarcinomas, 9 carcinoma of head of pancreas, 1 adenocarcinoma of duodenum）. Conclusion： Hypotonic-MRCP combined with Propeller LAVA dynamic multi-phase enhancement scanning might display the direct and indirect sign, which was effective in identifying the circumscription of the tumor and its extensionof periampullary diseases.