伴有乳头旁憩室的胆囊术后综合征的影像学诊断

目的探讨伴有乳头旁憩室(PAD)的胆囊术后综合征的影像学表现.资料与方法回顾性分析近20年来在我院诊治的50例伴有PAD的胆囊术后综合征患者的临床和影像学资料.结果 50例患者中发现54个PAD,位于乳头上方42个,乳头下方7个,乳头开口于憩室内3个,开口于憩室缘2个.PAD直径为0.5～5.0 cm,其中＞1 cm 42个(77.8%),同时合并胆管结石35例(70%),缩窄性乳头炎18例(36%),胆总管囊肿2例(4%),胰腺癌2例(4%),胆源性胰腺炎1例(2%).结论 MRCP和ERCP结合憩室造影对伴有PAD的胆囊术后综合征具有较高的病因诊断准确率,在本病的诊断中具有重要价值.鉴于MRCP的无创伤性和无并发症等优点,在胆囊术后综合征的诊断上可取代诊断性ERCP.     

十二指肠乳头旁憩室综合征影像学诊断价值的研究

目的　研究十二指肠乳头旁憩室 (PAD)综合征的影像学表现。对PAD进行分型和临床分级 ,提出合理的影像检查流程 ,以提高放射医师及临床医师对PAD综合征的影像诊断水平。资料与方法　回顾性分析经内镜证实的 117例PAD患者的临床及影像资料 ,分析PAD与胆胰管末端的位置关系。结果　 117例中显示 119个PAD ,其中乳头上型 71个 ,乳头下型 17个 ;乳头开口于憩室内 (憩室内型 ) 10个 ,乳头开口于憩室边缘 (憩室缘型 ) 2 1个。以憩室内型、边缘型和乳头上型易引起胆胰系统症状。合并肝外胆管扩张者 (直径 >1.0cm) 77例 (占 6 5 .8% ) ,相应PAD直径明显大于胆总管不扩张者 (P <0 .0 1)。结论　ERCP结合PAD造影及MRCP都是显示PAD及其与胆总管下段解剖关系的有效的影像检查手段 ,是诊断PAD综合征的理想方法 ,值得临床推广应用     

MRI对Lemmel综合征的诊断价值

目的 探讨MRI对Lemmel综合征的诊断价值.方法 选取66例临床确诊为Lemmel综合征患者的MRI资料进行回顾性分析,观察憩室的位置,评估其与肝胆胰疾病关系.结果 66例患者中发现十二指肠乳头旁憩室(PAD)66个,其中乳头上型61个,憩室内型5个;伴胆管扩张45例,胆管炎28例,胆总管结石20例,胆囊结石9例,...     

十二指肠乳头旁憩室伴胆胰疾病CT及MRI诊断

目的:探讨十二指肠乳头旁憩室伴胆胰疾病的CT和MRI诊断价值。方法:回顾性分析25例经临床随访证实的十二指肠乳头旁憩室伴胆胰疾病的CT和MRI表现,其中21例行CT平扫及增强,9例行MRI平扫、增强以及MRCP。结果:十二指肠乳头旁憩室CT及MRI表现壶腹周围含液气囊性病灶。MRCP表现为十二指肠内侧间壶腹部突出高信号囊性病灶。25例患者中合并胆胰病变CT和/或MRI表现为胆总管及肝内胆管结石13例,胆管扩张及壁增厚强化8例,胰腺肿胀3例,胰周脂肪层模糊4例及渗出2例,肾前筋膜增厚5例,胰管串珠样扩张2例。结论:CT及MR能显示十二指肠乳头旁憩室同时显示胆胰疾病引起胆管及胰腺形态学改变,有助于十二指肠乳头旁憩室伴胆胰疾病诊断。     

MRCP对乳头旁憩室综合征的诊断价值

目的评估MRCP对十二指肠乳头旁憩室综合征(PAD)的诊断价值。方法49例PAD患者行MRCP检查,分析其临床表现和影像征象,评估MRCP对PAD的检出率及显示PAD与胆胰管末端位置关系的能力。结果49例中46例MRCP显示47个PAD,其中1例为多发PAD(显示率为93.9%)。乳头上型34个、乳头下型7个、乳头开口于憩室边缘(憩室缘型)4个和乳头开口于憩室内(憩室内型)2个。结论MRCP作为一种新型的无创的成像手段,对PAD有着较高的显示率,对显示PAD与胆胰管末端的解剖关系及对乳头旁憩室综合征的诊断有着较大的价值和较为广阔的应用前景。     

MRCP诊断胆囊切除术后综合征89例

目的:探讨MRCP对胆囊术后病例的诊断价值。方法:搜集89例2002年3月～2004年3月因胆囊切除术 后出现腹痛等症状而行MRCP检查的病例,观察分析胆囊术后综合征的MRCP表现。结果:89例中合并胆管结石43例 (48.3%),残留胆囊或胆囊管残端过长29例(32.6%),缩窄性乳头炎21例(23.6%),十二指肠乳头旁憩室7例(7.9%), 胆管或胰腺癌肿7例(7.9%)。结论:MRCP对胆囊术后综合征具有较高的病因诊断符合率,在本病的诊断中具有重要价 值。     

胆囊切除术后综合征MRCP诊断并文献复习

目的 探讨磁共振胰胆管成像(MRCP)在诊断胆囊切除术后综合征的价值.方法 对49例胆囊切除术后综合征的MRCP资料进行回顾性分析.结果 胆囊残株过长6例,肝胆管结石21例,胆管损伤狭窄1例,十二指肠乳头旁憩室2例,肝门部胆管癌1例,胆胰管汇合异常16例,胆总管黏液性囊腺瘤2例.结论 胆囊切除术后综合征病因复杂,MRCP能够提供必要的影像学信息,为临床进一步治疗提供帮助.     

低张饮水后MRCP对十二指肠憩室分型及与胆道梗阻相关性的价值

目的探讨低张饮水后MRCP对十二指肠憩室的检出及分型的临床价值,评价憩室的发生部位与胆道梗阻程度的相关性。方法选取经上消化道钡餐及胃十二指肠镜确诊的78例DD患者的MRI资料,所有患者于常规上腹MRI平扫+MRCP(简称常规MRCP)后中止检查,低张饮水500~800 ml,20 min后再行横断T₂WI高分辨扫描+MRCP(简称低张力MRCP)检查,原始数据传送至ADW4.6工作站后处理,双盲法判定憩室数目、发生的部位及分型,评估胆道梗阻程度,分析憩室部位与胆道梗阻的相关性。结果78例DD患者中,常规MRCP发现憩室82个:憩室内型13个、边缘型40个、周围型23个、远离型6个,低张力MRCP检出憩室80个:憩室内型4个、边缘型29个、周围型41个、远离型6个。两种影像学检查对DD的检出差异无统计学意义(χ²=0.01,P>0.05)。低张力MRCP对憩室内型、周围型憩室的检出优于常规MRCP(χ²=4.13,P<0.05)、(χ²=3.97,P<0.05)。DD伴发胆道梗阻者56例,发生率为71.79%。DD发生的部位与胆道梗阻程度有相关性,其中憩室内型并发的胆道梗阻程度与周围型、远离型憩室并发的胆道梗阻程度之间的差异具有统计学意义(t=4.32,P<0.05)、(t=5.84,P<0.01)。结论十二指肠憩室是诱发胆道梗阻的重要原因,憩室的发生部位与胆道梗阻程度具有相关性,低张力MRCP有助于憩室的检出及准确分型。     

胰胆管疾病的ERCP影像诊断

目的评价内窥镜逆行胰胆管造影(ERCP)对胰胆管疾病的诊断价值。方法回顾性分析了经手术或病理及临床证实胰胆管疾病480例的ERCP表现,并与CT,MRI,MRCP,超声及透皮肝穿刺胆道造影(PTC)等检查方法进行对比。结果正常胰胆管75例,先天性胆管囊肿14例,胆系结石292例,奥狄括约肌狭窄症46例,壶腹癌、胆管癌52例,胰管癌4例,胰腺炎2例,胰管结石3例,胆道蛔虫症9例,肝内胆管发育变异2例,胆囊管异位开口6例,胆道-腹腔漏2例,十二指肠乳头旁憩室9例,十二指肠乳头开口于憩室内2例,肝移植后吻合口狭窄2例,肝移植后吻合口狭窄并胆漏1例,肝移植后肝外胆管条状结石2例。结论ERCP及MRCP检查同为诊断胰胆管疾病的“金标准”,但每种影像学方法均有其优缺点,应根据患者情况选择。ERCP虽有一定的创伤性,但检查同时可行内镜下乳头括约肌切开术(EST)等微创治疗。     

CT增强结合MR胰胆管造影诊断十二指肠乳头癌的价值

目的探讨十二指肠乳头癌的动态增强CT(DCE-CT)及MR胰胆管造影(MRCP)表现,评价其诊断价值。方法回顾性分析17例经病理诊断为十二指肠乳头癌的DCE-CT及MRCP表现。结果 17例十二指肠乳头癌中表现为十二指肠乳头结节或肿块、增强呈轻中度持续强化12例(70.6%);表现为十二指肠乳头区肠壁局限性或环形增厚伴异常强化2例(11.8%);表现为胆总管远端近乳头部结节影伴异常续强化者2例(11.8%),仅表现胆总管轻度扩张1例(5.8%)。MRCP示胰胆管梗阻平面位于十二指肠乳头部14例(82.4%),梗阻平面位于胆总管远端3例(17.6%);肝内外胆管扩张16例(94.1%),双管征12例(70.6%)。结论 DCE-CT能充分显示十二指肠癌强化特征及其与十二指肠壁的关系,MRCP则更有助于定位诊断,两者结合对该病有较高的诊断准确率。     

Value of MRCP using oral Gd-DTPA as negative contrast materials in diagnosis of atypical juxtapapillary duodenal diverticulum

ObjectiveTo investigate value of magnetic resonance cholangiopancreatography (MRCP) using oral diluted gadolinium (Gd)-diethylenetriamine penta-acetic acid (DTPA) as negative contrast materials in diagnosis of juxtapapillary duodenal diverticulum with atypical imaging features.MethodsNineteen patients with juxtapapillary duodenal diverticula of which imaging findings were atypical underwent MRCP using oral diluted Gd-DTPA as negative contrast materials after conventional MRCP without any oral contrast materials.ResultsTwenty diverticula were revealed in the 19 patients. At conventional MRCP, the diverticula appeared as rounded lesion with high signal intensity. After oral administration of diluted Gd-DTPA, they disappeared at MRCP. These entities were diagnosed as duodenal diverticula for they communicate with duodenal lumen.ConclusionMRCP using oral Gd-DTPA as negative contrast materials can be helpful in obtaining definitive diagnosis of those juxtapapillary duodenal diverticula without typical imaging features.     

Juxtapapillary diverticulum: findings on MRI

The purpose of our study was to describe the imaging findings of juxtapapillary diverticulum on magnetic resonance imaging (MRI). The MRI and magnetic resonance cholangiopancreatography (MRCP) examinations of 14 patients with juxtapapillary diverticula that were diagnosed on endoscopic retrograde cholangiopancreatography (ERCP) (N = 8) or endoscopy (N = 6) were retrospectively evaluated. T1-weighted spoiled gradient-echo, T2-weighted half Fourier single shot fast spin-echo (HASTE), and T2-weighted True FISP (fast imaging with steady state precession) images and thin-slice MRCP images were obtained on all patients. In five patients, diluted gadolinium DPTA (1/100) was used as an oral contrast. T2-weighted True FISP and HASTE images demonstrated air-fluid levels within all diverticula. Hyperintense oral contrast on T1-weighted spoiled gradient-echo images aided detection of the smaller diverticula. MRCP images obtained in the coronal plane best demonstrated the relationship of the diverticula to the papilla. MRI with the use of HASTE, True FISP, and oral contrast-enhanced T1-weighted sequences was able to depict juxtapapillary diverticula in our series.     

十二指肠乳头旁憩室致梗阻性黄疸的影像学诊断价值

目的:探讨十二指肠乳头旁憩室(PAD)致梗阻性黄疸的CT或MRI表现。方法:分析18例PAD伴梗阻性黄疸的CT或MRI表现,所有病例均经手术、上消化道钡餐检查或胃镜检查确诊。结果:本组18例中,憩室直径小于2 cm的11例,大于2 cm的7例。PAD的CT和MRI表现为胰头右后方与十二指肠之间圆形或半圆形含气囊袋影,可见液气平面,部分憩室内可见食物残渣影。18例PAD均伴有胆道系统不同程度的梗阻扩张。增强扫描憩室壁及相邻十二指肠局部肠壁明显强化。结论:CT和MRI对PAD致梗阻性黄疸有十分重要的诊断价值。     

多層螺旋CT對十二指腸乳頭旁憩室的診斷價值及臨床意義

目的:探討多層螺旋CT(MSCT)對十二指腸乳頭旁憩室的診斷價值。方法:對經MSCT和上消化道鋇餐(GI)檢查確診的60例十二指腸憩室患者的臨床和影像資料進行回顧性分析。結果:60例患者共發現十二指腸憩室73個,其中乳頭旁憩室58個。73個憩室中,直徑小于10 mm者11個,10~20 mm者38個,大于20 mm者24個。十二指腸乳頭旁憩室表現為十二指腸腔外的囊狀突出,可呈液性囊狀影、液-氣囊狀影及氣囊狀影等,大部分位于十二指腸與胰頭之間。MSCT能發現小于10 mm的憩室。結論:MSCT能同時發現十二指腸乳頭旁憩室及其伴發的膽胰疾病,對判斷兩者的關系具有較重要的臨床價值。影像科醫師應重視對十二指腸乳頭旁憩室的診斷。     

ERCP和MRCP在壶腹区梗阻性病变病因诊断中的对照研究

目的:分析MRCP在壶腹区梗阻性病变中的诊断价值及局限性。方法:搜集经手术和(或)ERCP病理证实的134例壶腹区梗阻性病变的MRCP和ERCP影像资料,并将其分为结石炎症组、恶性肿瘤组和乳头旁憩室组,进行对比分析。结果:134例壶腹区梗阻性病变共发现165个病因,MRCP和ERCP两种检查方法总的诊断准确率分别为79.4%和95.2%。胆总管下端结石和炎症112例,诊断准确率分别为96.4%和98.2%;壶腹区恶性肿瘤共31例,诊断准确率分别为58.1%和80.6%;十二指肠乳头旁憩室和憩室内乳头22例,诊断准确率分别22.7%和100%。结论:MRCP是无创性检查,可作为壶腹区梗阻性疾病的首选检查方法,ERCP可直视壶腹区情况并同时进行内镜下治疗或活检,两者结合互补,可提高壶腹区梗阻性疾病的诊断准确率。     

Duodenal diverticula mimicking cystic neoplasms of the pancreas: CT and MR imaging findings in seven patients

OBJECTIVE: Duodenal diverticula are common and are typically asymptomatic. When filled with gas or a combination of fluid and gas, duodenal diverticula are easily recognized on CT or MR imaging. However, a duodenal diverticulum that is entirely filled with fluid may mimic a cystic neoplasm arising from the head of the pancreas. We present seven cases of patients with duodenal diverticula in whom initial findings on CT or MR imaging were suggestive of a cystic neoplasm in the head of the pancreas. In all patients, this structure was ultimately proven to be a duodenal diverticula. CONCLUSION: When filled with only fluid, a duodenal diverticulum may mimic a cystic neoplasm in the head of the pancreas. Recognizing the location in which this entity characteristically arises and identifying small amounts of intradiverticular gas when it is present may aid in establishing the correct diagnosis in patients with duodenal diverticula.     

Computed tomography of duodenal diverticula

Duodenal diverticula are common and usually considered to be incidental findings. However, they may cause significant patient morbidity due to inflammatory or pressure effects and may be mistaken for pancreatic pathology on CT. We correlated the CT and upper gastrointestinal series appearance of duodenal diverticula in 14 patients, including two patients in whom erroneous diagnoses of pancreatic pseudocyst and pancreatic abscess were suggested based on CT findings. The duodenal diverticulum was visualized on CT in 10 of 14 patients (71%). The CT appearance was variable, with some diverticula containing air, fluid, contrast medium, or a mixture of the three.