口服钆喷酸葡胺稀释液改善胆道梗阻病变3D-MRCP图像质量的应用研究

Application of oral Dd-DTPA to improve 3D-MRCP image quality of biliary obstruction

目的:探讨口服静脉用钆喷酸葡胺稀释液改善磁共振胰胆管成像(Magnetic resonance cholangiopancreatography,MRCP)图像显示胆道梗阻病变的能力。方法:收集经江西省中西医结合医院临床诊断的胆道梗阻患者共60例,其中男40例,女20例,年龄(13.0~67.0)岁。所有患者均接受常规三维磁共振胰胆管成像(3D-MRCP)容积扫描和口服静脉用钆喷酸葡胺(Gd-DTPA)稀释液后3D-MRCP容积扫描,之后利用最大信号强度投影技术(MaximumIntensity Projection,MIP)进行图像重建。2名放射诊断医师分别以4分法对口服钆喷酸葡胺前后3DMRCP重建图像质量进行评分,主要评价胆道梗阻病变和胰胆管树整体显示情况,分别计算口服Gd-DTPA稀释液前后图像平均得分以及不同得分所占比例。采用组内相关系数评价2名医师对重建图像评分的可重复性。结果:(1)口服钆喷酸葡胺前后,3D-MRCP重建图像在2名放射科医师之间评分一致性优良。(2)口服钆喷酸葡胺后3DMRCP重建图像较口服Gd-DTPA稀释液前3D-MRCP重建图像质量评分更高,尤其是图像质量优秀的比率更高,差异有统计学意义(P<0.05)。结论:口服钆喷酸葡胺稀释液能有效减少3D-MRCP重建成像过程中胃肠道伪影干扰,提高MIP重建图像质量。

Objective:To investigate the ability of oral intravenous Gd-diethylenetriamine pentaacetic(Gd-DTPA)diluent to improve the reconstructed three-dimensional MRCP images of biliary obstruction lesions.Methods:A total of 60 patients with biliary obstruction were collected in Jiangxi Provincial Hospital of Integrated Traditional Chinese and Western Medicine,including 40 males and 20 females,aged 13.0-67.0 years.All patients underwent conventional 3D-MRCP volume scanning and 3D-MRCP volume scanning after oral Gd-DTPA,followed by image reconstruction using MIP technology.Two radiologists scored the image quality of reconstructed MRCP images before and after oral Gd-DTPA using a 4-point scale,mainly to evaluate the lesion of biliary obstruction and the overall display of biliary tract.The average score and the proportion of different scores were calculated respectively.The intra-class correlation coefficient was used to evaluate the repeatability of the scores between the two doctors.The scores before and after oral contrast agent were compared by paired sample Wilcoxon signed rank test.Results:(1)Before and after oral Gd-DTPA,the scores of reconstructed MRCP images between two radiologists were in good agreement.(2)The image quality score of 3D-MRCP after oral Gd-DTPA was higher than that of conventional 3D-MRCP,especially the proportion of excellent image quality was higher,and the difference was statistically significant(P<0.05).Conclusion:Oral Gd-DTPA dilution can effectively reduce gastrointestinal artifacts during 3D-MRCP,and can clearly improve the quality of 3D-MRCP images after MIP reconstruction.