磁共振胰胆管造影临床应用价值评价

Evaluation of the clinical applicable value of MR cholangiopancreatography

目的 :探讨磁共振胰胆管造影 (MRCP)在胆胰疾病中的应用价值。方法 :采用重T2 加权MR水成像技术对 73例患者行MRCP检查 ,图像经三维最大信号强度投影 (3D -MIP)及三维表面遮蔽显示技术 (3D -SSD)后处理。结果 :73例患者中 ,4例为正常胰胆管 ,6 9例胆胰疾病中 ,梗阻性黄疸者 5 8例 ,其中恶性胆道梗阻 43例 ,良性胆道梗阻 15例 ,非梗阻性病变 11例。在梗阻性黄疸病例中 ,MRCP定位准确率为 10 0 % ,并清楚显示扩张胆管程度及断端形态。对于恶性胆道梗阻 ,结合常规MRI可明显提高定性准确率 83.7% ,同时可显示肿块大小、范围及周围脏器侵犯情况。良性梗阻MR CP检查的定性准确率为 92 .9%。在非梗阻性病例中 ,MRCP可清楚描绘胆囊结石、胆系术后改变及含液丰富的病变 (胰腺假性囊肿、总胆管囊肿、十二指肠憩室等 )与胰胆管之间的毗邻关系。结论 :MRCP可准确揭示胆管梗阻部位 ,明确病变性质 ,MRCP对于非梗阻性胆胰疾病则有助于了解病变与周围脏器的毗邻关系。但MRCP作为一种影像检查技术 ,不能脱离常规CT、MRI 。

Objective:To evaluate the clinical applicable value of MR cholangiopancreatography(MRCP) in the diagnosis of biliary and pancreatic diseases.Methods:MRCP were performed in 73 cases use a heavy T 2 weighted MR hydrography technique,the images were postprocessed by three dimensional maximum intensity projectiony(3D-MIP)and three dimensional surface shaded display(3D-SSD).Results:In all 73 cases,4 cases showed normal biliary and pancreatic ducts.In 70 cases of biliary and pancreatic diseases,58 cases had objective jaundice,among them 43 cases were caused by malignant tumor,others were benign diseases.The rest 11 cases had no obstruction in the biliary and pancreatic duct.The diagnostic rate for obstructive level was 100% in the patients with obstructive jaundice,meanwhile it could visualized the dilation degree of the biliary duct and the obstructive ends.In the malignant biliary obstruction,the accuracy of diagnosis was 83.7%,MRCP also could manifested the size and length of the tumor and the invasion degree of the adjacent organs.In 15 cases of choledocholithiasis,the sensitivity and specificity and accuracy of MRCP was 94.4% and 100% and 94.4% individually.In the patients with no obstructive jaundice,MRCP could manifested the gallbladder stones,the changes after bile duct surgery and anatomic relation between pancreatic biliary duct and the diseases with abundant fluid (pancreatic pseudocysts,choledochal cysts,duodenal diverticulum).Conclusion:MRCP could reveal the obstructive site and diagnosis the quality of the disease accurately.It could also help to reveal the anatomic relation between the nonobstructive diseases between adjacent organs.Being a imaging technique,MRCP was a effetive supply to the traditional image techniques.