压缩感知磁共振胰胆管成像对胆总管良恶性梗阻的诊断价值

The value of compression-sensing magnetic resonance cholangiopancreatography in diagnosing benign and malignant obstruction of common bile duct

目的探讨屏气压缩感知磁共振胰胆管成像(breath-hold magnetic resonance cholangiopancreatography with compressed sensing,BH-CS-MRCP)鉴别诊断胆总管良恶性梗阻的价值。材料与方法招募临床确诊的胆总管梗阻患者,所有患者均行BH-CS-MRCP、呼吸导航的压缩感知磁共振胰胆管成像(navigator-triggered magnetic resonance cholangiopancreatography with compressed sensing,NT-CS-MRCP)和常规磁共振胰胆管成像(traditional magnetic resonance cholangiopancreatography,T-MRCP)序列扫描,并记录扫描时间。由两位影像诊断医师对三组MRCP的图像质量、胆管及胰管的显示度、梗阻病变的可视度和锐度、梗阻病变的良恶性判断进行评估。采取单因素方差分析比较三种序列图像评价指标的差异,分别计算其敏感度、特异度、准确度。结果68例胆总管梗阻患者,年龄(59.97±15.75)岁,男42例,女26例,良性梗阻49例,恶性梗阻19例。BH-CS-MRCP、NT-CS-MRCP、T-MRCP扫描时间分别为17 s、(210.61±38.52)s、(443.65±78.45)s。BH-CS-MRCP、NT-CS-MRCP、T-MRCP对图像总体质量、胆管(胆总管、一级胆管、二级胆管)、胰管的显示差异无统计学意义(P>0.05)。三种序列对梗阻部位病变的锐度及可视度的评分差异无统计学意义(P>0.05)。胆总管恶性梗阻诊断中,BH-CS-MRCP、NT-CS-MRCP的敏感度均为84.21%、特异度均为91.84%、准确度均为89.71%,T-MRCP的敏感度为84.21%、特异度为89.58%、准确度为86.76%。结论和T-MRCP相比,BH-CS-MRCP和NT-CS-MRCP可以利用较短的时间获得相当质量的图像及较好的胆总管良恶性梗阻的鉴别诊断效能。

Objective:To investigate the diagnostic efficacy of breath-hold magnetic resonance cholangiopancreatography with compressed sensing(BH-CS-MRCP)in the differential diagnosis of benign and malignant common bile duct obstruction.Materials and Methods:The patients with common bile duct were selected,and subjected to BH-CS-MRCP,navigator-triggered magnetic resonance cholangiopancreatography with compressed sensing(NT-CS-MRCP)and traditional MRCP(T-MRCP)scans,and the scanning time was recorded.The image quality,the visibility of the bile duct and pancreatic duct,the visibility and sharpness of obstructive lesions,and the benign and malignant judgment of obstructive lesions were independently evaluated by two radiologists.One-way ANOVA was used to compare the differences in the evaluation indexes of the three sequences,and the sensitivity,specificity,and accuracy were calculated.Results:Sixty-eight patients with common bile duct obstruction[age(59.97±15.75)years]were included in the study,including 42 males,26 females,49 benign obstructions,and 19 malignant obstructions.The mean acquisition time of BH-CS-MRCP(17 s),NT-CS-MRCP(210.61±38.52)s and T-MRCP(443.65±78.45)s were obtained,respectively.BH-CS-MRCP,NT-CS-MRCP,and T-MRCP showed no significant differences in the total quality,bile duct(common bile duct,primary bile duct,secondary bile duct),and main pancreatic duct(P>0.05).There were no significant differences in the sharpness and visibility of the obstruction lesions among the three sequences(P>0.05).The sensitivity,specificity,and accuracy of both BH-CS-MRCP and NT-CS-MRCP in the diagnosis of benign and malignant common bile duct obstruction were 84.21%,91.84%,and 89.71%,respectively.The sensitivity,specificity,and accuracy of T-MRCP were 84.21%,89.58%,and 86.76%.Conclusions:Compared with T-MRCP,BH-CS-MRCP and NT-CS-MRCP can acquire comparable image quality and better differential diagnostic efficiency of benign and malignant of common bile duct obstruction in a shorter time.