全腹部薄层冠状面单次激发快速自旋回波序列MRI检查诊断小儿胆管疾病的价值分析

Application of whole abdomen thin slice coronal single shot fast spin echo sequence of MRI in the diagnosis of children with intrahepatic and extrahepatic bile duct diseases

目的探讨全腹部薄层冠状面单次激发快速自旋回波序列MRI在小儿肝内外胆管成像中的应用。方法2014年10月~2016年9月收治的26例胆道系统疾病患儿(胆道闭锁症8例,胆道扩张症患儿14例,胆囊结石2例,胆管结石2例),所有患儿均采取全腹部薄层冠状面单次激发快速自旋回波序列扫描,其中9例患儿在延迟15~20 min后采取MRI增强扫描。观察所有患儿的肝内外胆道和各级分支的解剖全貌,分析其走行分布和通畅情况等。结果胆道闭锁症患儿肝内胆道均能够正常显示,而其中胆囊形态细小并且未见到肝外胆道显影者2例,肝外胆道和胆囊无显影6例。4例患儿肝脾肿大,2例患儿肝门区有三角形长T_2信号影;在胆道扩张症患儿中有11例患儿出现胆总管梭形扩张,有1例患儿表现为Caroli病,有2例患儿出现肝门区囊性包块,有4例患儿出现有胆囊增大和肝内胆道扩张;在胆系结石患儿中有3例患儿表现为胆总管局部管腔信号不均匀、短T_2信号的充盈缺损,胆囊结石患者表现为胆囊颈部短T_2信号的充盈缺损;与相同层面的扫描图像相比,延迟增强MRI扫描显示出肝脏、胰腺实质信号都有所减低,与胆胰管内长T_2信号的组织对比度则有所增加,其胆道系统显示更为清晰。结论相对于常规腹部MRI扫描而言,全腹部薄层冠状面单次激发快速自旋回波序列能够更加细致地观察患者胆道系统解剖结构,更为全面地了解患者病变全貌和是否存在其他脏器异常,临床应用具有很大的诊断意义。

Objective To investigate the application of whole abdomen thin slice coronal single shot fast spin echo sequence of MRI in the diagnosis of children with intrahepaitc and extrahepatic bile duct diseases.Method 26 children with biliary system diseases(biliary atresia in 8,biliary dilatation in 14,gall bladder stone in 2 and biliary stone in 2)were recruited in our hospital between October 2014 and September 2016.The full abdomen thin-layer coronal single excitation scanning fast spin echo sequence was performed,and MRI enhancement scanning was done in 9 cases after 15~20 minutes.The bile duct and its branches of livers inside and outside were observed.Result The intrahepatic bile duct was displayed properly in children with biliary atresia,and the shape of gallbladder was fine and did not show extrahepatic biliary duct in 2 cases,did not show bile duct and gallbladder in 6 cases.4 cases appeared with hepatosplenomegaly,2 cases demonstrated the long triangle T2 signal in the hepatic portal area;11 children with biliary dilatation showed common bile duct fusiformis dilatation,1 cases presented with Caroli disease,2 cases appeared hepatic cystic mass,and 4 cases appeared with enlarged gallbladder and intrahepatic biliary dilatation;children with biliary calculi had common bile duct lumen local uniformed signal,and short T2 signal filling defect.The gallbladder neck short T2 signal filling defect was observed in 1 child with gallbladder stones;as compared to the scanned images at the same level,the delayed enhancement of MRI scan showed the reduced liver and pancreatic parenchyma signal,and increased intraductal long T2 signal and the biliary system was more clear.Conclusion As compared with the conventional MRI scan,the whole abdomen thin coronal single shot fast spin echo sequences can provide more detailed observation in the biliary system in patients,especially in children,and give us a more comprehensive understanding of the whole lesions in clinical practice.