MR冠状面LAVA技术在低位胆道梗阻中的应用价值

The preoperative evaluation of low level biliary obstruction with coronal LAVA technique

目的:探讨磁共振冠状面快速三维容积动态增强(liver acquisition with volume acceleration,LAVA)在低位胆道梗阻中的应用价值。方法:50例低位胆道梗阻患者(排除较明显胆道结石者),进行MR平扫(包括MRCP)及冠状面LAVA检查,对检查结果进行判读与分析,包括病变的定位诊断、定性诊断及恶性梗阻的手术可切除性预测,并与手术病理、经内镜逆行性胰胆管造影术(ERCP)或经皮肝穿胆道造影术(PTC)结果对照。结果:MR平扫(包括MRCP)及冠状面LAVA技术对低位胆道梗阻的定位诊断准确率分别为86%(43/50)、88%(44/50),两组间无统计学差异(P=1.000);定性诊断准确率分别为78%(39/50)、92%(46/50),两组间差异具有统计学意义(P=0.039);MR平扫(包括MRCP)结合冠状面LAVA的手术可切除性预测准确率为90.3%(37/41)。结论:MR冠状面LAVA动态增强可以直观地显示病变的位置、特征及与周围组织的关系,在低位胆道梗阻的定性诊断中具有重要作用,MR平扫结合冠状面LAVA增强扫描对于低位恶性胆道梗阻术前可切除性预测准确率较高。

Objective：To evaluate the effect of coronal LAVA technique in the preoperative diagnosis of low level biliary obstruction.Methods：Fifty patients with low level biliary obstruction（obvious stones excluded） were examined by plain MR（MRCP included）and coronal LAVA technique.The assessments included positioning diagnosis,differential diagnosis and resectability prediction.The results were compared with pathological,ERCP or PTC results.Results：The accuracy of positioning diagnosis in plain MR and coronal LAVA groups was 86%（43/50） and 88%（44/50）;there was no statistical difference between two groups.The differential diagnosis in 2 groups was 78%（39/50） and 92%（46/50）;there was statistical difference（P=0.039）.The accuracy of predicting resectability was 90.3%（37/41）.Conclusion：Using MR coronal LAVA techniques,the location and nature of obstruction can be observed visually.As a result,it is important in the preoperative differential diagnosis.Plain MR combined with coronal LAVA scanning was effective in the respectability prediction of low level biliary obstruction.