MRI联合MRCP对肝门部胆管癌的诊断价值

Diagnostic value of MRI combined with MRCP for the hilar cholangiocarcinoma

目的探讨MRI与MRCP对肝门胆管癌(HCC)的诊断价值。方法30例手术病理证实的(HCC)患者均经增强前MRI及MRCP,20例还经动态增强MRI。获自上述3种方法的影像表现进行了对比性分析。结果MRCP对肝门部胆管梗阻水平定位准确率达93.3%(28/30),增强前与增强后MRI对病变的定性准确率为83.3%(25/30)。增强前后MRI联合MRCP对病变可切除性的术前评估准确率为80%(24/30)。MRCP显示了所有病例中肝内胆管不同程度扩张,肝门区胆管狭窄、中断或腔内充盈缺损。增强前MRI显示了30例中20例肝门区有稍长T1、稍长T2信号的肿块影。经动态增强MRI20例中17例其肿块表现为延迟期缓慢持续强化,而10例无肿块者表现为管壁增厚、强化,管腔狭窄。结论增强前后MRI可以显示HCC的特征性改变,如联合应用MRCP则有助于提高其定位、定性诊断准确率。

Objective To evaluate the diagnostic value of MRI combined with MRCP for the hilar cholangiocarcinoma （HCC）. Methods Thirty patients with surgically and pathologically proved HCC underwent precontrast MRI and MRCP.20 patients underwent additional postcontrast MRI.All the patients whose imaging findings from above three modalities were comparatively analyzed. Results The localized accuracy of MRCP for HCCs was 93.3%（28/30）.The qualitative accuracy of precontrast plus postcontrast MRI for HCCs was 83.3%（25/30）.The accuracy of MRI plus MRCP for preoperative evaluation of HCC reseetability was 80%（24/30）. MRCP showed more or less dilatation of intrahepatic bile ducts,stenosis and interruption or intraluminal filling defects of hilar bile ducts in all patients.Among 20 of 30 cases,precontrast MRI showed hilar mass-like shadows with light hypointense on T1WI and light hyperintense on T2WI.Among 17 of 20 patients who underwent postcontrast MRI,the masses appeared slow-continuous enhancement in delayed phase while 10 patients without mass were found to have thickening and enhancement of the duct walls and stenosis of the duct cavities.Conclusion MRI can show the characteristic changes of HCC,if combination with MRCP can elevate the localized and qualitative accuracy.