磁共振胰胆管成像对肝外胆管梗阻的诊断价值(附35例分析)

MR cholangiopancreatography for the diagnostic value of extrahepatic bile duct obstruction

目的 :探讨磁共振胰胆管成像对肝外胆管梗阻的诊断价值。方法 :对 35例肝外胆管梗阻性疾病行MRCP检查 ,MRCP采用呼吸门控重T2 FSE序列 ,把资源图像行MIP和 /或MPR法重建。全部病例与临床诊断或手术和病理对照分析。结果 :全部 35例MRCP检查均一次成功 ,且胰胆管显示满意。经手术病理证实或临床综合诊断 ,恶性胆管梗阻 2 8例(胆管癌 14例 ,胰头癌 11例 ,壶腹癌 2例 ,转移癌 1例 ) ,胆管结石 7例。MRCP对肝外胆管梗阻程度的判断和定位诊断准确率为 10 0 % ,总定性诊断准确率为 88.6 %。结论 :MRCP对肝外胆管梗阻定位诊断准确 ,结合资源图像和MR平扫 ,对肝外胆管结石和恶性梗阻的定性诊断均有较高的准确性。

Objective:To explore MR cholangiopancreatogrphy(MRCP)in the value of diagnosis of extrahepatic bile duct obstruction.Methods:MRCP was performed in thirty-five patients with extrahepatic bile duct obstruction.The fast spin-echo (FSE) was used for heavily T 2-weighted imaging,the maximum-intensity-projection (MIP)algorithm and the multiplanar-reconstruction (MPR) was made for three-dimensional (3D) reconstruction.Combining all cases with clinical diagnosis, pathological results and surgical findings, a constructive analysis was conducted.Results:MRCP was succeeded with one procedure in all 35 patients,and the bile duct was well displayed.28 cases with malignant bile duct obstruction,including bile duct carcinoma (n=14),pancreatic carcinoma (n=11),ampullar carcinoma (n=2),metastatic carcinoma (n=1), and 7 cases with bile duct stone were proved by surgical,pathological results and clinical comprehensive diagnosis.The accuracy of MRCP in localizing and qualitative diagnosis was 100% and 83.7% respectively.Conclusion:The localizing diagnosis of MRCP is accurate for extrahepatic bile duct obstruction. The qualitative diagnosis of MRCP is higher for extrahepatic bile duct stone and malignant bile duct obstruction.