钆贝葡胺增强磁共振胆道成像的可行性和临床意义

The Feasibility and Clinical Value of Gd-BOGTA Contrast-enhanced Magnetic Resonance Cholangiography

目的:对比磁共振肝特异性对比剂钆贝葡胺(Gd-BOPTA)增强胆道成像(CE-MRC)和三维磁共振胰胆管水成像(3D-MRCP)对肝胆管的显示能力,并探讨血清总胆红素(TBIL)水平对CE-MRC的影响。方法:我院诊治的157例肝胆疾病患者中,TBIL正常的40例受检者进行3D-MRCP、CE-MRC检查,Ⅰ级43例、Ⅱ级36例、Ⅲ级38例患者进行CE-MRC检查,行最大强度投影法(MIP)三维重组胆道系统,并与术中所见对照。结果:两种成像显示胆总管、胆囊、肝总管、肝内三级以下胆管效果的差异无统计学意义(P>0.05),3D-MRCP对肝内三级以上胆管显示优于CE-MRC(P<0.05),而CE-MRC在显示胆囊管方面优于3D-MRCP(P<0.05)。TBIL为Ⅰ级患者与正常者比较CE-MRC成像效果差别无统计学意义(P>0.05),Ⅱ级、Ⅲ级患者CE-MRC成像效果较正常者差(P<0.05)。结论:磁共振肝特异性对比剂钆贝葡胺增强可用于肝胆管成像,但CE-MRC成像效果受TBIL水平影响。。

Purpose： To compare the capabilities of magnetic resonance liver specific contrast agent gadobenate dirneglumine （GD-BOGTA） contrast-enhanced cholangiography （CE-MRC） and three-dimensional magnetic resonance cholangiopancreatography（3D-MRCP） in the display of bile duct, and to explore the effect of serum bilirubin level to CE-MRC. Methods： Altogether 157 patients with hepatobiliary diseases who had been treated in our hospital from July 2013 to December 2015 were selected as the research object. 3D-MRCP and CE-MRC were performed in 40 patients with normal serum total bilirubin（TBIL）, CE-MRC were performed in 43 patients with grade Ⅰ TBIL, 36 patients with grade Ⅱ TBIL, and 38 patients with grade Ⅲ with TBIL on a Philips Achieva 3.0T magnetic resonance imaging system. Maximum intensity projection（MIP） reconstruction of biliary system was processed on Philips central station. The capabilities of two methods in evaluating hepatobiliary anatomy was assessed and compared with findings during surgery. Results： There were no statistical significant difference（P〉0.05） between 3D-MRCP and CE-MRC in evaluating of bile common duct, gallbladder, hepatic common duct, and the branches of intrahepatic bile duct（P〉0.05）. 3D-MRCP is superior to CE-MRC in evaluating the intrahepatic bile duct before third level branches（P〈0.05）, while CE-MRC showed the cystic duct better than 3D-MRCP. There was no statistical significant difference in the effect of CE-MRC between patients with TBIL grade Ⅰ and with normal TBIL （P〉0.05）. The effects of CE-MRC imaging of patients with TBIL grade Ⅱ and grade Ⅲ were worse than those patients with normal TBIL, and the difference was with statistical significant （P〈0.05）. Conclusion： As a specific hepatic contrast medium, GD-BOGTA could be used in hepatobiliary duct imaging. CE-MRC imaging is influenced by the level of TBIL, the failure rate is high in patients with TBIL grade II and Ⅲ.