影像学检查在术前评估胆总管囊肿胰胆管解剖中作用

The role of imaging modalities for preoperative evaluation of the pancreaticobiliary anatomy in pediatric choledochal cyst

目的分析MRCP、CT增强(CE-CT)及术中胆道造影(IOCP)在显示儿童先天性胆总管囊肿(CC)患者胰胆管合流部解剖形态中作用,以期对术前提供可靠的影像资料。方法采用回顾性方法,收集儿童CC患者MRCP、CE-CT及IOCP资料,与囊肿病理组织学相对照,影像资料由两位放射科医师独立分析,然后以协商并达成一致影像诊断结论。结果59例CC中36例为囊性,23例为梭形。CC影像和手术分型:23例为I型,36例为IV型。MRCP、IOCP、CE-CT均能清楚显示肝内外胆管扩张情况,MRCP与IOCP诊断胰胆管合流异常(PBM)明显高于CE-CT,MRCP结合IOCP诊断PBM明显高于单独MRCP或IOCP。CE-CT可以明确显示肝右动脉位置异常。结论术前MRCP结合IOCP能提高CC患者胰胆管解剖结构显示率与PBM诊断率,而CE-CT可发现CC患者肝右动脉变异。

Objective To envaluate the role of magnetic resonance cholangiopancreatography （MRCP）, contrast enhanced computed tomography （CE-CT）, and intraoperative cholangiopancreatography （IOCP） in visualizing pancreaticobiliary anatomy for pediatric choledocal cyst （CC）. Methods 59 pediatric CC patients underwent hepaticojejunostomy at our institution, with imaging modalities of MRCP, CE-CT, and IOCP. Imaging findings were compared with histology and pathology. Two radiologists independently reviewed the imaging, then reached diagnostic conclusions by consensus. Results Among the 59 CC cases, the common bile duct showed cyst in 36 cases and fusiformis in 23 cases. As for imaging and surgery type, type [ was 23cases, type IV was 36 cases. Dilatation of the bile duet can be clearly visualized in MRCP, IOCP and CE-CT. The detect rate of PBM in MRCP, IOCP and CE-CT was 66%, 69% and 11%, respectively. Combination of MRCP and IOCP achieved rates of 81% in detecting PBM. Among 15 patients evaluated by CE-CT, 3 had the right hepatic artery positioned on the ventral side of the common bile duct. Conclusion Combining MRCP and IOCP can provide satisfactory pancreaticobiliary anatomical information and in- crease the detection rate of PBM for surgical planning in pediatric CC cases. CE-CT can be used to detect the right hepatic artery positioned on the ventral side of the common bile duct.