MRI诊断肝门胆管癌的优选方法:DWI,MRCP和冠状多期增强

Optimizing Scan Sequence and Method of Hilar Cholangiocarcinoma:MRI Coronal Scan of Multiphase Dynamic Enhanced,DWI and MRCP

目的探讨MRIDWI,MRCP和冠状多期动态增强相结合对肝门胆管癌的定性,定位,病变长度和范围,血管侵犯程度,淋巴结转移和可切除性评估的价值。方法22例梗阻性黄疸患者,初诊为肝门胆管癌,采用1.5TMR行肝门常规轴位T1WI,T2WI,DWI,3DMRCP,冠状多期动态增强,延迟期加做一次轴位扫描,所有病例经手术病理证实。结果22例肝门梗阻性黄疸患者在肝门水平DWI见异常高信号,3DMRCP在肝门水平显示胆管截断18例,狭窄4例,22例冠状动态多期增强全部直接显示了病变胆管与"胆管树"的关系,病变胆管局部管腔显示不同程度的环形狭窄,各期均匀强化,以延迟期强化明显,并可直接测量病变侵犯长度。肝门淋巴结肿大6例,部分包绕门静脉5例。结论MRIDWI,MRCP和冠状动态多期增强能够比较直观的,真实地反映肝门胆管癌的影像学特点和大体病理特征,为进一步提高肝门胆管癌的诊断符合率和可切除性评估提供了更多的诊断根据和信息。

Objective To investigate the value of qualitation and location diagnosing hilar cholangiocarcinoma, and the assessment of the tumor extent, vascular involvement, lymph node metastasis, and tumor resectability by combining multiphase dynamic enhanced MRI in coronal with DWI, MRCP. Methods T1WI, T2WI, DWI （SE-EPI b=600s/mm^2）, 3D MRCP, and 4 phase dynamic enhanced imaging of the hepatic hilum were performed for 22 patients with preliminary diagnosis of hilar cholangiocarcinoma, in the delayed phase axial scan performed again. All of cases were confirmed by postoperative pathology. Rosults There are all strong intensity in the hepatic hilar level on DWI of 22 hilar cholangiocarcinoma patients. 3D MRCP showed hilar bile duct 18 desected, 4 narrowed. Coronal scan of multiphase dynamic enhanced MRI has all discovered directly the relations between affection bile duct and ＂bite duct tree＂ in 22 hilar cholangiocarcinoma. The affections displayed various intensify in the every phase of multiphase dynamic enhanced MRI with coronal scan, but intensify obviously in the delayed phase, and the longitudinal extent of affections can be measured directly.The portal lymph node was swellen in 6 patient, 5 cases portal vein were partly surrounded and 2 of 5 cases transformed. Gonclosion Combining MRI coronal scan of multiphase dynamic enhanced with DWI, MRCP can reflect veritably and visualized the feature of imaging and pathology of hilar cholangiocarcinoma, The study can increase diagnose accordance rate of hilar cholangiocarcinoma, and it provide further information and diagnostic evidence for resectable evaluation.