华支睾吸虫性胆管炎的MRI表现

MRI manifestations of cholangitis caused by Clonorchis sinensis

目的探讨华支睾吸虫性胆管炎的MRI影像表现及其诊断价值。方法回顾性分析2015年11月至2017年8月期间广西柳州市中医医院经临床确诊的15例华支睪吸虫病患者的临床MRI影像表现,其中6例行增强扫描,5例行磁共振胰胆管造影(MRCP)检查。结果 15例患者均有不同程度胆管扩张,其中轻度扩张10例,中度扩张4例,重度扩张1例。轻度扩张表现为肝包膜下肝内胆管条状、杵状或小囊状扩张,同时伴有Ⅰ~Ⅱ级胆管及肝外胆管轻度扩张,中度扩张表现为由肝门向被膜方向逐级扩张,同级胆管远近端扩张较一致,重度扩张呈"软藤"样扩张。MRCP检查3例表现轻度胆管扩张,1例表现中度扩张,1例重度扩张。增强扫描4例胆管壁无明显强化,2例胆管壁增强扫描各期轻度强化。1例合并肝硬化及肝癌。结论华支睾吸虫性胆管炎MRI表现有一定的特征性,认识并撑握这些特征,再结合寄生虫实验室检查,对提高诊断的准确性有很大的帮助。

Objective To investigate magnetic resonance imaging（MRI） manifestations and diagnostic value of cholangitis caused by Clonorchis sinensis. Methods A retrospective analysis was performed for the clinical MRI manifestations of 15 cases of patients with cholangitis caused by Clonorchis sinensis and confirmed by clinical diagnosis, including 6 cases of enhanced scanning and 5 cases of magnetic resonance cholangiopancreatography（MRCP） examination, who admitted to Liuzhou Traditional Chinese Medicine Hospital from November 2015 to August 2017. Results All the 15 patients had different degrees of dilatation of the bile ducts, including 10 with mild dilation, 4 of moderate dilation and 1 of severe dilatation. Mild dilatation was manifested by intrahepatic subcapsular intrahepatic bile duct strip, clubbing or small capsular dilatation, accompanied by Ⅰ~Ⅱ grade bile duct and extrahepatic bile duct. Moderate dilatation was manifested by a gradual expansion from the hilar to the membrane, and the far and near terminal dilatation of the same grade bile duct was more consistent. Severe expansion was manifested by expansion like＂soft rattan＂. The results of MRCP showed three cases of mild bile duct dilatation, one case of moderate dilatation and one case of severe dilatation. There no obvious enhancement of bile duct wall in 4 cases of enhanced scanning, but slight enhancement of bile duct wall in 2 cases of cases of enhanced scanning in each period. One case was complicated with liver cirrhosis and liver cancer. Conclusion The MRI features of cholangitis caused by Clonorchis sinensis have certain characteristics. To recognize and hold these features, combined with the parasite laboratory tests, can improve the accuracy of the diagnosis.