胰胆管水成像和稳态快速成像技术在胆总管梗阻疾病的诊断价值

Comparison of MR cholangiopancreatography with fast imaging employing steady state acquisition in the diagnosis of common bile duct obstruction disease

目的:比较2D、3D胰胆管成像(MRCP)和稳态快速成像技术(FIESTA)三种成像技术对胆总管系统梗阻疾病的诊断价值。方法:回顾性分析均行2D、3D MRCP及FIESTA三种序列成像的胆总管梗阻疾病的病例44例,其中胆总管结石35例,胰头癌3例,急性胰腺炎3例,胆囊癌2例,十二指肠恶性肿瘤1例。依据图像质量评价标准对44例2D、3D MRCP和FIESTA图像质量进行评价,并以手术为金标准,采用χ^(2)检验比较2D MRCP、2D联合3D MRCP以及2D、3D MRCP联合FIESTA三种成像对胆总管梗阻疾病诊断准确率的差异。结果:2D MRCP、3D MRCP、FIESTA三种成像图像质量差异有统计学意义(P<0.05),2D MRCP的图像质量要优于3D MRCP及FIESTA,而后两者图像质量无明显差异。44例中2D MRCP诊断准确率为77.3%,2D MRCP联合3DMRCP诊断准确率为88.6%,2D、3D MRCP联合FIESTA诊断准确率为97.7%,三种方法诊断准确率差异有统计学意义(P<0.05)。结论:三种成像序列中,2D MRCP的图像质量优于3DMRCP及FIESTA;2D和3D MRCP联合FIESTA成像技术能明显提高胆总管梗阻疾病的诊断正确率,更全面揭示胆管梗阻疾病病因,具有较高的临床应用价值。

Objective:To compare the diagnostic value of 3 imaging techniques,2D and 3D MR cholangiopancreatography(MRCP)and fast imaging employing steady state acquisition(FIESTA),in the diagnosis of obstructive diseases of the common bile duct system.Methods:A total of 44 cases of choledocholithiasis were retrospectively analyzed with 2D,3D MRCP and FIESTA sequences,including 35 cases of choledocholithiasis,3 cases of pancreatic head cancer,3 cases of acute pancreatitis,2 cases of gallbladder cancer,and 1 case of duodenal malignant tumor.The quality of 2D,3D MRCP and FIESTA images of the 44 cases was evaluated according to the image quality evaluation criteria,and the difference in the diagnostic accuracy of 2D MRCP,2D combined with 3D MRCP,and 2D,3D MRCP combined with FIESTA imaging for choledochal obstruction disease was compared by using theχ^(2) test with the surgery as the gold standard.Results:The differences in the image quality of 2D MRCP,3D MRCP,and FIESTA were statistically significant(P<0.05),and the image quality of 2D MRCP was better than that of 3D MRCP and FIESTA,while there was no significant difference in the image quality of the latter two.The diagnostic accuracy of 2D MRCP was 77.3%in 44 cases,the diagnostic accuracy of 2D MRCP combined with 3D MRCP was 88.6%,and the diagnostic accuracy of 2D MRCP combined with 3D MRCP was 88.6%.In 44 cases,the diagnostic accuracy of 2D MRCP was 77.3%,2D MRCP combined with 3D MRCP was 88.6%,and 2D and 3D MRCP combined with FIESTA was 97.7%,and the difference in diagnostic accuracy among the three methods was statistically significant(P<0.05).Conclusions:Among the three imaging sequences,the image quality of 2D MRCP was better than that of 3D MRCP and FIESTA;2D and 3D MRCP combined with FIESTA imaging technology can significantly improve the diagnostic correction of choledochal obstruction and more comprehensively reveal the etiology of choledochal obstruction,which is of high clinical application value.