一站式磁共振成像评估儿童胆总管囊肿和胰胆管解剖结构价值分析

One-stop magnetic resonance imaging in typing and evaluating pancreaticobiliary duct anatomy in children with choledochal cysts

目的 采用一站式磁共振成像(MRI)评价儿童胆总管囊肿(CC)分型和胰胆管解剖结构。方法 2019年6月~2022年6月我院诊治的CC儿童患者136例,均接受一站式MRI、CT和胆道造影检查,参照Todani、Kurumi和Komi分类法进行分型。结果 本组Todani分型发现Ⅰa型93例(68.4%)、Ⅰb型5例(3.7%)、Ⅰc型5例(3.7%)、Ⅱ型16例(11.8%)、Ⅲ型3例(2.2%)和Ⅳ型14例(10.3%);Kurumi分型显示C型106例(77.4%)、L型5例(3.7%)、R型7例(5.1%)、A型9例(6.6%)和P型9例(6.6%);Komi分型发现A型47例(34.5%)、B型60例(44.1%)、C型16例(11.8%)和无合流异常13例(9.5%);一站式MRI检查发现胆管正常、变异和胰胆管合流异常分别为80.1%、19.8%和83.8%,均显著不同于CT扫描的94.1%、5.8%和69.1%(P<0.05),而与胆道造影结果非常接近(分别为80.1%、19.8%和86.8%)。结论 使用一站式MRI扫描评估CC儿童囊肿分型和胰胆管解剖结构更灵敏、更准确,建议优先选择检查。

Objective This study was to conducted to evaluate one-stop magnetic resonance imaging(MRI)in typing and evaluating pancreaticobiliary duct anatomy in children with choledochal cysts(CC).Methods 136 children with CC were encountered in our hospital between June 2019 and June 2022,all underwent one-stop MRI,CT and intraoperative cholangiography,and the CC was evaluated based on Todani,Kurumi and Komi typing.Results Out of our children with CC,the Todani typing showed typeⅠa in 93 cases(68.4%),typeⅠb in 5 cases(3.7%),typeⅠc in 5 cases(3.7%),typeⅡin 16 cases(11.8%),typeⅢin 3 cases(2.2%)and typeⅣin 14 cases(10.3%);the Kurumi typing demonstrated type C in 106 cases(77.4%),type L in 5 cases(3.7%),type R in 7 cases(5.1%),type A in 9 cases(6.6%)and type P in 9 cases(6.6%);the Komi typing showed type A in 47 cases(34.5%),type B in 60 cases(44.1%),type C in 16 cases(11.8%)and normal pancreaticobiliary duct confluence in 13 cases(9.5%);the one-stop MRI scan showed that the percentages of normal biliary ducts,biliary duct variation and pancreaticobiliary maljunction were 80.1%,19.8%and 83.8%,which very similar to 80.1%,19.8%and 86.8%by cholangiography,significantly different as compared to 94.1%,5.8%and 69.1%(P<0.05)revealed by CT scan.Conclusion One-stop MRI scan is more sensitive and accurate in typing CC and evaluating pancreaticobiliary duct anatomy,and we recommend it as a priority choice of check-up for children with CC.