常规MRI、DWI及MRCP在胆总管泥沙样结石诊断中的应用价值

The Value of Conventional Magnetic Resonance Imaging, Diffusion-Weighted Imaging and MRCP in the Diagnosis of Biliary Sludge in Commen Bile Duct

目的探讨常规MRI、DWI及磁共振胰胆管成像(MRCP)在胆总管泥沙样结石中的诊断价值。方法回顾性分析52例经内镜逆行胰胆管造影(ERCP)证实的胆总管泥沙样结石的患者资料,术前均行上腹部常规MRI、DWI及MRCP检查,并对胆总管管腔内信号进行分析。结果胆总管管腔内T_(1)WI上出现高信号16例(30.8%),T_(2)WI上出现低信号19例(36.5%),DWI上出现等或稍高信号19例(36.5%),MRCP上胆总管管腔内出现充盈缺损或信号减低15例(28.8%)。胆总管出现管腔扩张23例(44.2%)。上述特征中,至少出现1种征象者39例(75%),仅出现1种及同时出现2、3、4、5种者分别为13例、7例、5例、5例和6例(25.0%,13.5%,9.6%,9.6%,11.5%)。13例MRI及MRCP未见明显异常征象。结论常规MRI、DWI及MRCP对胆总管泥沙样结石具有较高的诊断价值,但仍存在假阴性,ERCP可作为重要的辅助诊断手段。

Objective To assess the Value of conventional magnetic resonance imaging,diffusion-weighted imaging and MRCP in the diagnosis of biliary sludge in common bile duct.Methods 52 patients with biliary sludge in common bile duct confirmed by endoscopicretrograde cholangiopancreatography were retrospectively analyzed.All of patients were preoperatively examined with conventional MRI,DWI(3.0T,b=0 and 800 s/mm^(2))and MRCP and the images were observed.Results It was observed that the hyperintensity on T_(1)WI was observed in 30.8%(16/52),hypointensity on T_(2)WI was observed in 36.5%(19/52),isointensity or slight hyperintensity on DWI was seen in 36.5%(19/52).The filling defect or the decreased signal intensity in the lumen of common bile duct on MRCP was 28.8%(15/52).The luminal dilatation of the common bile duct was observed in 44.2%(23/52).The probability of occurrence of at least one of the above imaging characteristics was 75%(39/52),and the occurrence of 1,2,3,4 and 5 concurrently were 25.0%,13.5%,9.6%,9.6%and 11.5%respectively.No abnormalities were observed in 13 patients on both of MRI and MRCP.Conclusion Conventional MRI,DWI and MRCP has high diagnostic value for the diagnosis of biliary sludge in the common bile duct,but there are still false negatives.ERCP can be used as an important complimentary method.