腹腔镜胆囊切除术前磁共振胰胆管成像显示胆囊三角的检查方案优化探讨

Assessment of Calot's triangle before laparoscopic cholecystectomy with MR cholangiopancreatography : Optimization of the examination program

目的通过比较7个磁共振胰胆管成像(MRCP)序列在不同患者配合度的情况下胆囊三角的空间显示图像质量,优化MRCP检查方案。方法对100例患者行7个成像序列的MRCP检查,根据患者不同的屏气(B)与呼吸触发(R)配合度(1～3级)分成B1R1、B1R2、B1R3、B2R1、B2R2、B2R3、B3R1、B3R2、B3R3组,共9组。由2名放射科医师使用双盲法对重建后胆囊三角图像质量进行评价,并进行统计学分析。结果 9组7个MRCP成像序列重建后胆囊三角图像质量评分差异有统计学意义(P<0.01)。B1R1组、B1R2组及B1R3组Fiesta 3DB图像质量最佳;B2R1组、B2R2组Fiesta 3DB、FRFSE 3DB、FRFSE 3DR图像质量好;B2R3组Fiesta 3DB、FRFSE 3DB图像质量好;B3R1组、B3R2组FRFSE 3DR图像质量最好;B3R3组FRFSE 3DB、SSFSE 2DB Thk图像质量好。结论腹腔镜胆囊切除术(LC)术前MRCP检查显示胆囊三角的最佳方案为:屏气配合度1级首选Fiesta 3DB;屏气配合度2级,呼吸配合度1级或2级的可选用FRFSE3DR、Fiesta 3DB、FRFSE 3DB,呼吸配合度3级的可选用Fiesta 3DB、FRFSE 3DB;屏气配合度3级,呼吸配合度1级及2级的采用FRFSE 3DR,呼吸配合度3级的可选用FRFSE 3DB、SSFSE 2DB Thk。

Objective To evaluate and compare the imaging quality of 7different MR cholangiopancreatography（MRCP） sequences with different degrees of respiratory cooperation in patients,in order to optimize MRCP examination program.Methods MRCP examination with 7different sequences was performed in 100patients prospectively.According to the cooperation（grade 1 — 3） of breath holding（B） and respiratory triggering（R）,the patients were divided into 9groups ： Group B1R1,B1R2,B1R3,B2R1,B2R2,B2R3,B3R1,B3R2and B3R3.Qualitative analyses of the Calot＇s triangle on the reformatted imaging were performed independently by 2radiologists.The differences of imaging quality among all the groups were evaluated statistically.Results Imaging qualities in 7different sequences in 9groups were statistically different（P〈0.01）.Fiesta 3DB sequence had the best imaging quality in groups of B1R1,B1R2and B1R3.Fiesta 3DB,FRFSE 3DB and FRFSE 3DR sequence had better imaging quality for B2R1,B2R2.Fiesta 3DB,FRFSE 3DB sequence had better image quality for B2R3.FRFSE 3DR had the best image quality for B3R1and B3R2.FRFSE 3DB,SSFSE 2D B Thk had better image quality for B3R3.Conclusion The best MRCP examination program for displaying Calot＇s triangle before laparoscopic cholecystectomy（LC） is ： Fiesta 3DB for patients with the first degree of breath holding;FRFSE 3D R,Fiesta 3DB,FRFSE 3DB for patients with the first degree of breath holding and the first or second degree respiratory triggering,while Fiesta 3DB,FRFSE 3DB for the third degree of respiratory triggering;FRFSE 3DR for patients with the third degree of breath holding and the first or second degree respiratory triggering,while FRFSE 3DB,SSFSE 2DB Thk for the third degree of respiratory triggering.