钆塞酸二钠MRI增强在肝门部恶性梗阻性黄疸中临床应用探讨:附17例报告

Clinical application of gadolinate disodium in the enhancement of MRI in malignant obstructive jaundice of hilar(report of 17 cases)

目的探讨钆塞酸二纳(Gd-EOB-DTPA) MRI增强检查在肝门部恶性梗阻性黄疸病变中的临床应用价值。方法回顾性分析解放军总医院自2016年8月至2019年3月收治的17例肝门部恶性梗阻性黄疸患者为研究对象。分析17例患者的MRI征象、肝胆特异期各肝段相对强化程度、MRI胰胆管造影(MRCP)和Gd-EOB-DTPA MRI胆管造影(MRC)显示情况;同时,比较其中12例经临床干预患者的肝胆特异期各肝段相对强化程度变化情况。结果 MRI征象:17例患者中,11例表现为肝门部结节和肿块,3例表现为胆管壁不均匀增厚,3例肝外病变肝门部淋巴结转移表现为多发肿大淋巴结并压迫肝门部胆管狭窄。肝胆特异期各肝段相对强化程度及肝功能:17例患者共136个肝段,其中,10个肝段功能正常,40个肝段轻度损伤,44个肝段中度损伤,42个肝段重度损伤;12例经临床干预后共剩余92个肝段,其中,58个肝段相对强化程度增加,肝功能损伤改善,10个肝段无明显变化,24个肝段相对强化程度减低,肝功能损伤加重。MRCP:17例患者均表现为肝内胆管不同程度扩张,梗阻段胆管缺失,其下方肝总管、胆总管无明显扩张,6例引流管均显示。Gd-EOB-DTPA MRC:9例肝内胆管不同程度显示,其中的5例肝门部胆管狭窄变细,5例胆总管显示;4例引流管内有对比剂充盈;8例肝内外胆管均不显示。结论 Gd-EOB-DTPA MRI增强检查可在术前对肝门部恶性梗阻性黄疸病变准确定性和定位,并能够清晰显示胆管梗阻情况,而其特有的肝细胞摄取功能可评价相应肝段功能,对临床精准干预具有指导意义。

Objective To investigate the clinical value of gadolinate disodium( Gd-EOB-DTPA) MRI in the diagnosis of malignant obstructive jaundice. Methods A retrospective study was performed on 17 cases of patients with malignant obstructive jaundice disease who were admitted from August 2016 to March 2019. The MRI signs of 17 patients,the relative degree of enhancement of each hepatic segment in the hepatobiliary specific stage,MRI cholangiopancreatography( MRCP) and Gd-EOB-DTPA MRI cholangiography( MRC) were analyzed. At the same time,the changes of relative strengthening degree of each liver segment in 12 patients with hepatobiliary specific stage after clinical intervention were compared. Results MRI findings: among the 17 patients,11 showed hilar nodules and masses,3 showed uneven thickening of the bile duct wall,and 3 showed multiple enlarged lymph nodes with compression of hilar bile duct stenosis. The relative strengthening degree and liver function of each liver segment in hepatobiliary specific stage: 17 patients had a total of 136 liver segments,among which,10 liver segments had normal function,40 liver segments had mild injury,44 liver segments had moderate injury,and 42 liver segments had severe injury. After clinical intervention,a total of 92 liver segments were left in12 cases,among which,58 liver segments showed increased relative enhancement and improved liver function injury,10 liver segments showed no significant change,and 24 liver segments showed decreased relative enhancement and aggravated liver function injury.MRCP: all the 17 patients showed different degrees of intrahepatic bile duct dilatation,with absence of bile duct in the obstruction segment,no obvious dilatation of common hepatic duct and common bile duct below,and all the 6 patients showed drainage tube. Gd-EOBDTPA MRC: the intrahepatic bile duct in 9 cases was shown to different degrees,among which 5 cases had narrowed bile duct stenosis in hilar and 5 cases had common bile duct and 4 cases had contrast agent filling in the drainage tube. No intrahepatic or extrahepatic bile duct was observed in 8 cases. Conclusion The enhanced MRI examination of Gd-EOB-DTPA can accurately characterize and locate the malignant obstructive jaundice lesion of hepatic hilum before surgery,and can clearly show the situation of bile duct obstruction,and its specific liver cell uptake function can evaluate the corresponding liver segment function,which has guiding significance for accurate clinical intervention.