不同组织起源的壶腹周围癌磁共振成像诊断分析

The diagnosis and analysis of MRI of vater ampulla carcinoma from different tissue origins

目的分析不同组织起源的壶腹周围癌磁共振成像(MRI)、磁共振胰胆管造影(MRCP)影像学表现,评价MRI及MRCP在壶腹周围癌诊断及鉴别诊断中的作用。方法收集22例经手术病理证实的不同组织起源的壶腹周围癌MRI影像学表现及临床资料,回顾分析其MRI及MRCP影像学特征,并与手术和病理学结果进行对照。结果 22例壶腹周围癌中,胰头癌6例,胆总管下端癌7例,壶腹癌7例,乳头周围十二指肠腺癌2例。壶腹周围癌的MRI主要表现是病变处胆管壁不规则增厚、腔内结节或胆管周围软组织肿块,从而导致胆管和/或胰管管腔不规则狭窄、截断,并病变近端胆管和/或胰管扩张。22例均出现不同程度胆系扩张,其中8例梗阻端截断,7例胆总管壁增厚、管腔不规则狭窄,4例梗阻端肿块。7例胆总管下端癌中4例(57%)出现"三管征",6例胰腺癌出现"四管征"2例(33%)。"三管征"和"四管征"是胆总管下端癌及胰头癌较为特征性MRCP表现。结论 MRI及MRCP在对不同组织起源的壶腹周围癌的诊断中,定位准确,定性诊断也具有较高特异性。

Objective To analyze the MRI and MRCP performances of VPC from different tissue origins ,and evaluate value of MRI and MRCP in diagnosis and differential diagnosis of VPC. Methods MRI findings and clini- cal materials of 22 cases by surgical pathology were collected, MRI and MRCP findings of them were analyzed retro- spectively, and were compared with operative and pathological results. Results In 22 cases of VPC 6 cases of carci- noma of head of pancreas, 7 cases of distal common bile duct carcinoma , 7 cases of ampulla carcinoma, 2 cases of duodenal adenocarcinoma. The MRI main appearances of VPC were irregularly thickened of duct wall , nodule of the cavity, or tissue mass around the bile duct, leading to irregular stenosis and truncation of bile duct and / or pancreatic duct, the dilatation of bile duct and/or pancreatic duct of the lesion. All the 22 cases showed dilatation of different degrees of the bile duct, including 8 cases of obstruction truncation, 7 cases of bile duct wall thickening, lumen is irregular stenosis, 4 cases of obstruction end mass. Seven cases of distal common bile duct carcinoma in 4 cases （57%） appeared in ＂three tube syndrome＂, 6 cases of pancreatic cancer in the appearance of ＂four tube＂ sign in 2 cases （33%）. ＂Three tube syndrome＂ and ＂four tube syndrome＂ of the common bile duct carcinoma and carcinoma of head of pancreas are characteristic MRCP features. Conclusion MRI and MRCP in the diagnosis of VPC from different tissue origins, accurate positioning, qualitative diagnosis has high specificity.