磁共振仿真胆管镜的胆胰十二指肠结合部外科意义初探

Surgical Significance of MR Virtual Cholangioscopy in Diseases at Junction of Bile-pancreatic Ducts and Duodenum

目的 探讨磁共振仿真胆管镜 (MRVC)对胆胰十二指肠结合部病变的手术指导作用。 方法 分析 6 7例胆胰十二指肠结合部病变的磁共振胆胰成像 (MRCP)资料 ,并作仿真内镜 (VE)和最大强度投影 (MIP)或表面阴影显示(SSD)重建成像研究。MRCP采用冠状面二维快速自旋回波重T2 序列薄层无间隔扫描 ,内镜成像利用导航软件在工作站进行后处理。 14例与纤维胆管镜检查作了对照。 结果 VE内镜样立体展示了胆、胰管和十二指肠内腔情况 ,对病变状态尤其病变与胆胰十二指肠的局部解剖关系显示较好 ;结合MIP或SSD图像 ,准确揭示了胆胰管树的整体情况。病灶以远伴有胆胰管扩张者显示尤佳 ,扫描前适量饮水者胆胰十二指肠结合部显示好。MRVC对胆管内或侵犯胆胰管病变的准确检出率达 10 0 %,十二指肠病变的VE显示率为 40 %,胆胰管汇合处、胆总管出口的VE显示率分别为 31.3%( 2 1 6 7)和 38.8%( 2 6 6 7)。 结论 磁共振仿真胆管镜无创性地提供了胆胰管和十二指肠内镜解剖图像 ,可指导胆胰十二指肠结合部病变外科术式的合理选择。

Objective To assess the surgical value of magnetic resonance virtual cholangioscopy(MRVC) in diseases at the junction of bile-pancreatic ducts and duodenum. Methods Source of imaging data sets of MR cholangiopancreatography(MRCP) were analyzed in 67 cases of diseases at the junctions of pancreatic-bile ducts and duodenum. Virtual endoscopy(VE) as well as images of maximum intensity projection(MIP) and shaded surface display(SSD) were reformed by navigator software on the workstation (Advantage Windows 3.1,GE). MRCP was obtained by MR hydrography using 2D coronal heavily T 2 -weighted fast spin echo sequences. Fourteen cases underwent choledochoscopy during the surgical operation. Results VE provided endoscopic views of bile-pancreatic ducts and duodenurn, and well showed the status of the nidus and local anatomy of the junction of bile-pancreatic ducts and duodenum especially in cases who had appropriate water drinking just before the scanning. Combining with the images of MIP or SSD,it depicted excellently the whole anatomy of bile-pancreatic ducts. The MRVC detectability of pancreatic-bile duct lesions was 100%, 40% for duodenum diseases. The sensitivity for the conjunction of common bile duct and pancreatic duct, exit of common bile duct was 31.3% and 38.8% respectively.It was difficult,however,for MRVC to evaluate accurately the stricture of bile-pancreatic ducts,or to differentiate the mucosal color and fluid characteristics. Conclusions MRVC depicts noninvasively the endoscopic like anatomic image of the pancreatic-bile ducts and the duodenum, which is very useful for planning and simulation of the surgical procedure.