T2WI-MRC和CE-MRC检查在胆道疾病诊断中的应用价值

Effectiveness of Application of T2WI-MRC and CE-MRC in Diagnosis of Bile Duct Diseases

目的：探讨MR胆管水成像（T2WI-MRC）和钆贝葡胺增强后胆管成像（CE-MRC）在胆道疾病诊断中的应用价值。方法选取2012年4月~2014年7月我院收治的78例胆道疾病患者作为研究对象，所有患者均进行T2WI-MRC及CE-MRC检查，以术中胆管造影作为金标准，比较两种检查方法对肝内外胆管的显示情况。结果在肝内三级以上胆管的显示方面，CE-MRC显示68例（87.2%），T2WI-MRC显示41例（52.6%），差异有统计学意义（χ2=27.524，P=0.000）；在肝内三级以下胆管、胆总管、胆囊、胆囊管、肝总管的显示方面，差异无统计学意义（P〉0.05）。两种方法对解剖变异的诊断符合率均为100%；在肝胆管狭窄、肝胆管扩张的诊断上，差异不具有统计学意义（P〉0.05）。结论 T2WI-MRC成像具有成像速度快、成像质量好等优点，但对某些微小的三级以上胆道显示较差。CE-MRC对胆道狭窄具有较高的诊断准确率，可以在一次屏气下完成全肝扫描，呼吸不均匀者也能进行检查，但缺点是引入了造影剂，增加了患者费用，并且潜在增加了过敏反应。临床诊断中，要根据实际需要，合理选择成像方法。

ObjectiveTo discuss the effectiveness of application of T2WI-MRC and CE-MRC in diagnosis of the bile duct diseases.Methods Altogether 78 patients with bile duct diseases who had been treated from April 2012 to July 2014 in our hospital were selected as the research object. All the patients were scanned by T2WI-MRC and CE-MRC. Taking intra-operative cholangiography as the gold standard, the extra-hepatic bile duct images obtained by two different methods were compared. Results CE-MRC diagnosed 68 （87.2%） cases of intra-hepatic bile ducts above Level 3; T2WI-MRC diagnosed 41 （52.6%） cases of intra-hepatic bile ducts above Level 3, which existed statistically signiifcant differences （χ2=27.524,P=0.000）. No statistically signiifcant differences were seen in display of intra-hepatic bile ducts below Level 3, gallbladder, cystic ducts and common bile ducts （P〉0.05）. The diagnostic accordance rate of two methods in diagnosing anatomical variations were both 100%. There were no significant differences in diagnosis of bile duct stricture and dilation between two methods （P〉0.05）.Conclusion T2WI-MR showed its advantages in fast imaging and good image quality but also displayed slight disadvantage in poor display of some tiny bile ducts above Level 3. CE-MRC had a high diagnosis rate and could be completed in a single breath-hold whole liver scan. Patients with non-uniformed breath also could accept CE-MRC scanning. However, its disadvantage was the introduction of the contrast agent and the additional costs for patient as well as potentially-increased allergies reaction. Therefore, the imaging diagnosis methods shall be reasonably selected according to actual needs.