胆道低位梗阻的 MRCP 影像分析

Analysis of MRCP images of lower bile duct obstructive diseases

目的探讨胆道低位梗阻性疾病的 MRCP 影像特征,分析 MRCP 在胆道低位梗阻诊断中的价值。方法 260例胆道低位梗阻病人,以 FSE 序列行 MRCP 扫描,以 MIP 法行3D重建,对影像诊断与手术发现及病理诊断结果进行对比分析。结果237例手术治疗,MRCP 对胆总管结石、胆总管蛔虫均能明确诊断,对胆管炎性狭窄、胰腺炎可以进行诊断,但有一部分病例可误诊为胆总管占位、胰腺占位,对胰上段胆总管癌诊断较可靠,壶腹癌的MRCP表现为双管扩张征,MRCP 对梗阻部位的诊断率可达100%。结论 MRCP 不仅能判断胆道低位梗阻的具体部位,而且还可以根据影像特征分析病变性质。

Purpose To explore MRCP imaging features of lower bile duct obstructive diseases (LBDODs)and investigate the value of MRCP in diagnosis of these diseases.Methods A total of 260 patients with LBDODs were examined with FSE-sequence MRCP scanning.Meanwhile,3D images were reconstructed by MIP method.In 237 patients,the diagnostic results by imaging were compared with operational or pathological ones.Results Correct diagnoses of bile duct stone and ascorid could be obtained by MRCP.Using the technique,the inflammatory stenosis of common bile duct(CBD) and pancreatitis could be detected in most of the cases.However,false diagnosis might be made for some diseases such as tumor of CBD or that of pancreas.As for diagnosis of the tumor of CBD above the level of pancreas,MRCP was good.Ampulary tumor showed the sign of double—tube dilatatiorn. The rate of correct diagnosis of obstructive sites by MRCP was as high as 100%.Conclusions Both the locations and pathological features of LBDODs can be determined by MRCP.