LAVA动态增强磁共振成像在肝外胆管癌诊断中的应用

Application of LAVA dynamic contrast enhanced magnetic resonance imaging in diagnosis of the extrahepatic bile duct carcinoma

目的:探讨LAVA动态增强磁共振成像(MRI)对肝外胆管癌诊断的准确性和临床意义。方法:回顾性分析28例临床怀疑肝外胆管癌患者的LAVA动态增强MRI资料。所有病例均行1.5 T磁共振T1加权成像(T1WI)、T2加权成像(T2WI)、扩散加权成像(DWI)及阵列空间敏感编码技术(ASSET)、LAVA动态增强磁共振成像(LAVA-DCE MRI)。结果:28例患者均经病理证实,肝门区胆管13例,胆总管上段3例,中段5例,胆总管下段4例,壶腹部3例。平扫:病灶T1WI呈低信号、稍低信号或等信号,T2WI呈高信号、稍高信号和等信号,DWI呈稍高信号或高信号。LAVA动态增强:动脉期肿块轻度强化5例,门脉期肿块轻-中度强化16例,延迟期肿块延迟强化7例。本组病例中分别有3例肝门区胆管癌误诊为肝细胞型肝癌,2例胆总管下段癌误诊为胆管炎,诊断准确率为82.1%。结论:LAVA动态增强MRI对肝外胆管癌的诊断具有重要价值。

Objective： To discuss the diagnostic accuracy and clinical value of LAVA dynamic contrast enhanced magnetic resonance imaging（ MRI） on the extrahepatic bile duct carcinoma. Methods： The MRI data of 28 cases suspected extrahepatic bile duct carcinoma were studied with T1 WI,T2WI,diffusion weighted imaging（ DWI）,array spatial sensitivity encoding technique（ ASSET）,and LAVA dynamic contrast enhanced magnetic resonance imaging（ LAVA-DCE MRI）. Results： 28 patients were proved by pathology,13 cases of hilar bile duct,3 cases of the upper section of common bile duct,5 cases of the middle section of common bile duct,4 cases of the lower section of common bile duct,3 cases of the ampullar region. Plain scan： T1 WI showed low signal,slightly low signal or equisigna,T2 WI showed high signal,slightly high signal or equisigna,DWI showed slightly high signal or high signal. LAVA-DCE MRI： 5 cases were showed mild enhancement in the arterial phase. 16 cases were showed mild to moderate enhancement in the venous phase. 7 cases were showed delayed enhancement in the delayed phase. In this group 3 cases of hilar bile duct carcinoma were misdiagnosed hepatocellular carcinoma,2 cases of the lower section of common bile duct carcinoma were misdiagnosed cholangitis. The diagnostic accuracy rate was 82. 1%.Conclusion： LAVA dynamic contrast enhanced magnetic resonance imaging has important value in diagnosis of the extrahepatic bile duct carcinoma.