Mirizzi综合征的多层螺旋CT和MRI表现

Multi-Spiral CT and MRI Manifestations of Mirizzi Syndrome

目的探讨Mirizzi综合征(MS)的影像学特征,提高术前诊断率。资料与方法回顾性分析40例经病理证实为MS患者的多层螺旋CT(MSCT)和MRI资料。结果Ⅱ~Ⅳ型患者中Ⅱ型21例,Ⅲ型10例,Ⅳ型1例,根据图像显示可评估瘘口28例;Ⅴ型患者中Ⅴa型7例,Ⅴb型1例,均可直接评估瘘口。25例胆囊萎缩,38例胆囊管或胆囊管-肝总管汇合部结石>1 cm,36例肝内外胆管扩张。40例患者中,MRI显示瘘口29例,结石29例,术前漏诊12例。MSCT显示瘘口26例,结石16例,术前漏诊16例。MSCT与MRI显示结石差异有统计学意义(P<0.05)。结论胆囊-胆总管瘘、胆肠瘘为MS的直接征象;胆囊萎缩、胆囊管或胆囊管-肝总管汇合部结石>1 cm、肝内外胆管扩张为MS的间接征象。在结石的显示上,MRI较MSCT有优势。

Purpose To explore the imaging features of Mirizzi syndrome(MS)and improve the preoperative diagnosis rate.Materials and Methods MSCT and MRI data of 40 patients with MS typeⅡ-Ⅴconfirmed by pathology were retrospectively analyzed.Results There were 21 cases of typeⅡ,10 cases of typeⅢ,1 case of typeⅣin typeⅡ-Ⅳpatients,28 cases of fistulae could be evaluated according to the image display;7 cases of type Va and 1 case of typeⅤb in typeⅤwere all directly evaluated fistula.There were 25 cases of gallbladder atrophy,38 cases of cystic duct or cystic duct-common hepatic duct junction stones>1 cm,and 36 cases of dilated intrahepatic and extrahepatic bile ducts.Among the 40 patients,MRI showed 29 cases of fistula,29 cases of stones,and 12 cases of missed diagnosis before surgery.MSCT showed 26 cases of fistula,16 cases of stones,and 16 cases of missed diagnosis before surgery.MSCT and MRI showed statistically significant differences in the display of gallstone(P<0.05).Conclusion Gallbladder-common bile duct fistula and biliary intestinal fistula are the direct signs of MS;gallbladder atrophy,cystic duct or gallbladder duct-common hepatic duct confluent stones>1 cm,and dilation of intrahepatic and extrahepatic bile ducts are indirect signs of MS.In the display of stones,MRI has an advantage over MSCT.