恶性胆道梗阻的磁共振胰胆管造影诊断

MR Cholangiopancreatography for the Diagnosis of Malignant Bile Duct Obstruction

目的 评价磁共振胰胆管造影 (MRCP)对胆道恶性梗阻性疾病的诊断价值。材料与方法 43例恶性胆道梗阻患者 (胆管癌 15例 ,壶腹癌 4例 ,胰头癌 10例 ,转移性癌 10例 ,原发性肝癌 4例 )行MRCP检查 ,结合PTC、ERCP检查、手术、病理结果、临床资料进行综合分析。结果 43例患者MRCP检查均一次成功 ,胆管及扩张胰管显示满意 ,定位诊断准确率为 10 0 % ,定性准确率为83 .7%。肝门区癌肿MRCP表现为肝门区不规则或类圆形信号缺损 ,肝内胆管扩张以肝门区为中心呈“枯枝”状或“蟹足”样扩张 ;肝外胆管癌胆管断端呈横形或“鸟嘴”样截断 ;壶腹癌胆管断端呈横形、“鸟嘴”样或“鼠尾”状截断 ;胰头癌胆管断端呈“鸟嘴”样或“鼠尾”状截断 ,90 % (9/10 )伴“双管征” ;转移性癌肿MRCP表现与转移部位有关 :转移至肝门附近与肝门区癌肿相似 ,肝外转移者与相应部位胆管癌、胰头癌相似 ,常规MRI可见明确转移肿块或淋巴结。结论 MRCP是胆道恶性梗阻影像学检查的有效补充手段 ,可为恶性胆胰肿瘤术前可切除性提供评价 ,对不可切除的癌肿行介入治疗提供参考。

Objective To evaluate MR Cholangiopancreatography (MRCP) in the diagnosis of malignant bile duct obstruction.Materials and Methods MRCP was succeeded with one procedure in all 43 patients, and the bile duct was well displayed. The accuracy of MRCP in localizing and qualitative diagnosis was 100% and 83.7%, respectively. On MRCP, hepatic portal carcinoma demonstrated irregular or oviform signal loss in hepatic portal area, and dilatation of the intrahepatic ducts presenting as “withered tree branches” or “crab's claws”. The obstructed end in extrahepatic bile duct carcinoma showed abrupt cut off or “beak like” appearance. In ampullar carcinoma the obstructed end displayed abrupt cut off, or “beak like”, or “mouse tail” appearance, while in pancreatic head carcinoma “beak like”, or “mouse tail” appearance with “double duct” sign (9/10, 90%). In metastatic carcinoma the signs on MRCP were related to the metastatic site. Results MRCP was performed in 43 patients with malignant bile duct obstruction, including bile duct carcinoma (n=15), ampullar carcinoma (n=4), metastatic carcinoma (n=10) and primary hepatic carcinoma (n=4). Combined with PTC, ERCP, surgical findings and pathological results, a comprehensive analysis was conducted.Conclusion MRCP is an effective supplement to conventional MRI in diagnosing malignant bile duct obstruction. It can help make a preoperative assessment of the potential of resection and provide useful information for interventional therapy when the tumor is unresectable.