口服联合静脉注射钆喷酸葡胺改善磁共振胰胆管成像图像质量及临床应用

目的：评价口服联合静脉注射钆喷酸葡胺（Gd—DTPA）增强在抑制胃肠道高信号及腹部小血管高信号中的作用,改善磁共振胰胆管成像（MRCP）图像质量以提高对胰胆管病变的诊断及鉴别诊断水平。方法：在体外及临床实验的基础上．选取2mL静脉用Gd—DTPA配制成100mL浓度为0．01mol／L的稀释液作为最佳浓度和容量的MRCP口服用胃肠道阴性对比剂。对21例疑有胰胆管病变的患者行联合口服及静脉注射Gd—DTPA增强后10min行MRCP检查．分析增强前后胰胆管及病变的显示情况。结果：21例患者口服联合Gd-DTPA增强MRCP图像上,来自胰胆管树背景上的小血管信号影以及胃、十二指肠内潴留液高信号被明显抑制．肝脏和胰腺实质信号强度显著降低,使得胰胆管树各解剖结构的对比度提高,显示更加清楚,图像质量较口服联合Gd—DTPA增强前明显改善。结论：对于明确或高度怀疑有胰胆管病变的患者,口服联合静脉注射Gd—DTPA增强能抑制胃、十二指肠内潴留液的高信号以及胰胆管树背景上的小血管信号,能进一步改善MRCP图像质量,结合动态增强T1WI能为胰胆管病变的诊断及鉴别诊断提供更多帮助。

Combination of oral and intravenous Gd-DTPA for the quality of MRCP imaging and its clinical application

Objective To assess the effect of oral combined with intravenous Gd-DTPA enhancement on suppressing the high singals from the gastrointestinal tract and the small abdominal vessels and to enhance the diagnosis and differentiation level of pancreaticobiliary disorders by improving the quality of MRCP imaging. Methods An oral negative gastrointestinal contrast agent of MRCP was generated from 2 mL of intravenous Gd-DTPA,with an optimal concentration of 0.01 mol/L and volume of 100 mL. 21 patients with suspected pancreaticobiliary diseases received MRCP 10 min after being administered oral combined with intravenous Gd-DTPA enhancement. The images of the common bile duct and pancreatic duct and the lesions were analyzed before and after enhancement. Result On the images with oral combined with Gd-DTPA enhancement, the small vessel signals overlapped upon the pancreaticobiliary tree and the high signals from fluid retention in the stomach and the duodenum were suppressed completely and the signal intensity of the hepatic and pancreatic parenchyma markedly reduced, leading to an increase in the contrast of the anatomic structures of the pancreaticobiliary tree and marked improvement of the quality of MRCP imaging. Conclusions For those with highly suspected pancreaticobiliary disorders, oral combined with Gd-DTPA enhancement can completely suppress the high signals from fluid retention inside the stomach and the duodenum and the small vessel signals overlapped upon pancreaticobiliary tree, and further improve the quality of MRCP imaging. In combination with dynamic enhanced T1WI, it is more helpful in the diagnosis and differentiation of pancreaticobiliary disorders.