胆道扩张的形态学MR表现对胆道梗阻性病变的诊断分析

Diagnostic value of morphological characteristics of bile duct dilatation in the diagnosis of biliary obstructive diseases

目的根据胆道扩张的形态学的影像表现对不同胆道梗阻性病变进行分析,判断其原发病灶的性质。方法收集我院2014年1月~2016年3月共计95例梗阻性黄疸患者,行磁共振成像及磁共振胰胆管造影(MRCP)检查,所有患者进行手术或逆行胰胆管造影(ERCP)检查获得病理结果。根据所有患者的影像学资料分析其肝内胆管扩张的程度、形态,肝外胆管扩张末端变化,梗阻部位及原发病性质。结果良性梗阻多为轻度胆管扩张,呈枯枝状;即使中度扩张也极少呈软藤状,而较多呈残根状。恶性梗阻多为中、重度胆管扩张,且多呈软藤状;高、中位胆道梗阻多见于恶性病变,低位胆道梗阻良性与恶性病变发生的比例相近;恶性梗阻扩张肝外胆管末端突然中断,良性梗阻扩张肝外胆管末端逐渐变细。结论磁共振胰胆管成像对良、恶性胆道梗阻病病变具有较高的诊断价值,分析胆道扩张的形态特征,对鉴别良、恶性梗阻病变有较大意义,有利于指导临床治疗。

Objective To analyze the morphological characteristics of bile duct dilatation in different biliary obstructive diseases, and to determine the nature of the primary lesion. Methods In our hospital from January 2014 to March 2016, a total of 95 patients with obstructive jaundice underwent magnetic resonance imaging （magnetic resonance, imaging, MRI） and magnetic res- onance cholangiopancreatography （magnetic resonance, cholangiopancreatography, MRCP） examinations were gathered, all pa- tients underwent surgery or endoscopic retrograde eholangiopancreatography （endoscopic retrograde, eholangio-pancreatography, ERCP） to check the pathological results. According to the imaging data of all the patients, the extent and shape of intrahepatic bile duct dilatation were analyzed, and the changes of the distal end of the bile duct dilatation, the site of obstruction and the na- ture of the original disease were analyzed. Results Benign obstruction presented with mild dilatation of the bile duct and, a mod- erate expansion of deadwood ; even rarely like soft rattan, and the more was the residual root shape. For the malignant obstruction and severe dilatation of the bile duct, and the more was like soft rattan ; the high and median biliary obstruction was seen in malig- nant lesions, the occurrence of biliary obstruction of benign and malignant lesions was similar to malignant obstruction ; extrahepatic bile duct ended abruptly, benign obstruction extrahepatic bile duct ended tapering. Conclusion The diagnostic value of mag- netic resonance cholangiopanereatography is higher in benign and malignant biliary obstruction diseases. Analysis of morphological features of biliary tract dilatation has great significance in differential diagnosis of benign and malignant obstruction and for guiding clinical treatment.