MRI联合MRCP在诊断胆管癌中的应用

Application of MRI Combined with MRCP in the Diagnosis of Bile Duct Carcinoma

目的分析磁共振成像(MRI)联合磁共振胰胆管造影(MRCP)对胆管癌的诊断价值。方法对我院2012年1月至2020年3月收治的50例胆管癌患者的临床资料进行回顾性分析,均行MRI、MRCP,“金标准”为手术病理结果,分析MRI联合MRCP的诊断价值,分析胆管癌在MRI及MRCP上的表现及病灶形态学。结果手术病理结果显示,50例胆管癌患者病灶在肝内胆管4例,肝门部胆管30例,肝外胆管10例,壶腹部6例;MRI联合MRCP定位诊断符合率100.00%高于MRI 92.00%,差异有统计学意义(P<0.05)。胆管癌的MRI表现为胆管壁出现块影,存在不同程度的胆管扩张,胆管结构局限性偏心性狭窄或者突然截断,T_(1)WI一般呈现为稍低的信号,T_(2)WI通常出现稍高的信号。胆管癌的MRCP表现为成比例扩张,软藤状改变。乳头状型病灶出现息肉状或腔内结节状变化;肿块型病灶出现肝门部不规则结节状肿块信号;浸润型病灶的胆管壁出现僵硬增厚。结论MRI对胆管癌病变组织及正常组织的分辨率较高,MRCP能显示胆胰管病灶形态,两者联合在诊断胆管癌的应用中具有良好效果。

Objective To analyze the diagnostic value of magnetic resonance imaging(MRI)combined with magnetic resonance cholangiopancreatography(MRCP)for bile duct carcinoma(BDC).Methods The clinical data of 50 patients with BDC in the hospital were retrospectively analyzed between January 2012 and March 2020.All underwent MRI and MRCP.Taking the results of surgical pathology as the golden standard,diagnostic value of MRI combined with MRCP was analyzed.The manifestations and morphology of BDC in MRI and MRCP were analyzed.Results The results of surgical pathology showed that of the 50 patients with BDC,there were 4 cases,30 cases,10 cases and 6 cases with lesions located in intrahepatic bile duct,porta hepatis bile duct,extrahepatic bile duct and ampulla.The positioning diagnosis coincidence rate of MRI combined with MRCP was higher than that of MRI(100.00%vs 92.00%)(P<0.05).In BDC manifestations by MRI,there were block shadows on bile duct walls,different degrees of bile duct dilatation localized and eccentric stenosis or sudden truncation of bile duct structure,slightly lower signals on T_(1)WI and slightly higher signals on T_(2)WI.In BDC manifestations by MRCP,there was proportional dilatation and changes of soft cane.There were polyps or nodular changes in papillary lesions.In mass-type lesions,there were irregular nodular mass signals in hilar.In infiltrative lesions,there was stiffness and thickening on bile duct walls.Conclusion MRI has high resolution ratio for BDC tissues and normal tissues,while MRCP can display lesions morphology of bile duct and pancreatic duct.Their combination has good diagnosis effect for bile duct carcinoma.