硬化性胆管炎的影像学特征

Imaging diagnosis of sclerosing cholangitis

目的:探讨影像学方法对硬化性胆管炎的诊断价值.方法:回顾性分析经内镜逆行胰胆管造影(endoscopic retrograde cholangiography,ERCP)和手术探查证实的34例硬化性胆管炎患者的影像学资料.患者术前均行计算机断层扫描(computed tomography,CT)、磁共振胰胆管造影(magnetic resonance cholangiopanceatography,MRCP)以及磁共振成像(magnetic resonance imaging,MRI)三者中的一种或两种以上检查.由两名从事影像诊断的高年资医生在对患者临床资料和诊断结果不知情的情况下对图像进行诊断和测量.包括分析每例患者胆道系统、肝脏及其他相关脏器的影像学特征.结果:34例硬化性胆管炎患者中原发性硬化性胆管炎有6例,男性5例,女性1例,继发性硬化性胆管炎患者28例,男性15例,女性13例.继发性硬化性胆管炎患者中胆管阻塞、微生物感染和Ig G4相关的硬化性胆管炎分别为20、1、7例.原发性硬化性胆管炎主要影像表现为肝内外胆管增厚,呈局灶性、节段性狭窄,胆管树呈剪树征.继发性硬化性胆管炎主要表现为肝外胆管增厚,呈局灶性、节段性、弥漫性狭窄,胆管树呈穿珠征和剪树征,部分硬化性胆管炎患者可出现胆管壁强化和肝脏动脉期局灶性异常灌注,患者到了疾病中晚期均会伴有不同程度肝硬化表现.Ig G4相关性继发性硬化性胆管炎患者以肝外胆管病变为主,常伴有自身免疫性胰腺炎表现.结论:影像学对于硬化性胆管炎的诊断具有一定的特征性,结合临床资料,大部分患者可作出正确诊断.

AIM：To explore the diagnostic value of imaging in sclerosing cholangitis（SC）.METHODS：A total of 34 SC patients after endoscopic retrograde cholangiography（ERCP）and common bile duct exploration were included.The clinical data and imaging findings were retrospectively reviewed.The images were independently recorded by two radiologists ina blinded,randomized manner for the imaging features of the biliary system,the liver and otherrelated signs.RESULTS：Six patients had primary sclerosing cholangitis（PSC）,and 28 patients had secondary sclerosing cholangitis（SSC）.Bile duct obstruction,microbial infection and IgG 4-related SC were seen in 20,1 and 7 patients,respectively.PSC showed thickening of the intrahepatic and extrahepatic bile duct walls,and focal and segmental strictures.Pruned-tree and diverticulum-like appearances were more frequent in PSC.SSC showed thickening of the extrahepatic bile duct wall,and focal,segmental and long strictures.Beaded and pruned-tree appearances were more frequent in SSC.The bile duct wall enhancement was found in SC.The hepatic perfusion disorder was found in the arterial phase in SC.There was liver cirrhosis in patients with advanced stage disease.Ig G4-related SC mainly showed extrahepatic bile duct stenosis with autoimmune pancreatitis.CONCLUSION：SC has some radiological characteristics.A correct diagnosis can be made by imaging combined with clinical data in the majority of patients.