胆管磁共振仿真内窥镜的临床应用研究

MR virtual endoscopy: a study of clinical applications in cholangiopancreatography

目的 通过胆管磁共振仿真内窥镜 (MRVE)加磁共振胰胆管造影 (MRCP)的临床应用 ,探讨其在胆道方面的诊断价值。方法 14个月内 44例有梗阻性黄疸和有胆道症状的患者行胆管MRVE检查。用呼吸门控快速自旋回波 (FSE)和屏气多层单次激发快速自旋回波 (SSFSE)序列获得的二维重度T2 WI传输到计算机工作站 ,用导航软件显示利用表面应答技术的胰胆管内表面的状态。结果 恶性肿瘤 18例 ,胆结石 17例、术后胆道并发症 3例、其他胆道病变 6例。MRVE清晰地显示了胆道的解剖结构、扩张的胰管、胆道的狭窄和梗阻、胆道结石、胆管分支和病理性梗阻的内壁形态。仿真内窥镜的主要局限性是不能评价黏膜和缺乏病理诊断。在发现胆管扩张和梗阻部位方面 ,二维快速自旋回波的敏感性为 91.7% ,而单次激发快速自旋回波为 97.9%。结论 非损伤性MRVE能显示胆管结构 ,提供完整的胆道三维影像 。

Objective To determine the added clinical applications of MR virtual endoscopy (MRVE) plus MRCP in cholangiopancreatography. Methods In 14 month, 44 patients with obstructive jaundice and symptomatic bile trace were assessed by MRVE in biliary tract.The 2D data of heavily T 2 weighted images with FSE(non breath hold, respiratory trigger) and SSFSE(breath hold, multi slice single shot fast spin echo) sequence were transferred to the computer workstation. Navigator software (GEMS) was used to display intraluminal views of the pancreaticobiliary tract with a surface rendering technique. Results Patients suffered from neoplasm ( n =18), bile stone (17), postoperative complications of cholecystectomy( n =3), and other disease of biliary tract( n =6). MRVE could clearly demonstrate the anatomical structures in biliary tract, extended pancreas tract,biliary meatus narrowing and obstruction, bile duct stones, duct branches, and the inner wall of pathological obstruction.The main limitation of virtual endoscopy was inability to evaluate mucosa and lack of histological diagnosis. Sensitivity for detection of bile duct dilatation and site of obstruction was: 2D FSE 91 7%, and SSFSE 97 9%. Conclusion MRVE provided noninvasively endoscope like display of biliary tract.Its display ability was a supplement to image biliary trace. MRVE effect of multi slice SSFSE sequence was better than that of fast spin echo.