中场MRCP临床应用价值的初步探讨

目的 初步探讨中场ＭＲＣＰ对诊断胆胰疾病的临床指导价值。方法 采用０．５Ｔ中场磁共振机，对２８例胆胰疾病患临床治疗前行ＭＲＩ及ＭＲＣＰ检查。其中９例为胆系术后且Ｂ超或ＣＴ检查可疑胆胰疾病患，把ＭＲＣＰ检查结果与临床治疗后结果进行对比分析。结果 中场ＭＲＣＰ可清晰显示胆道梗阻性疾病的胆管胰管扩张程度和范围，对胆总管结石、胆管肿瘤、先天性胆总管囊肿、原发性硬一胆管炎及胰腺癌、转移淋巴结等胆管外压性疾病具有较高的诊断与鉴别诊断价值；但亦有假阳性与假阴性存在，如１例胆总管死蛔虫及１例肝左叶胆管癌均误诊为结石、２例胆总管较小结石漏诊等，２例急性胰腺炎ＭＲＣＰ周边均可见散与腹膜后积液“雪花”征存在，ＭＲＩ可弥补ＭＢＣＰ不能显示胆管外信息资料的不足。结论 结合ＭＲＩ的ＭＲＣＰ对胆管疾病临床诊断与治疗有着重要指导价值。尤其

Preliminay study of clinical application with middle - field MRCP

Purpose To explore the clinical value for diagnosing pancreaticobiliary diseases by middle ?field MR cholangiopancreatography (MRCP). Methods Both MRCP and MR imaging( MRI) were performed in 28 cases with pancreaticobiliary diseases. 9 cases of all had suffered from the biliary system operaton and were suspected pancreaticobiliary diseases by B - mode ultrasound or CT. MRCP results was compared with the clinical treatment ones.Results In all cases,MRCP could clearly display the dilatation degree and range of pancreaticobiliary duct.MRCP had the significant value in diagnosis and disdngishing diagnosis of choledocholithiasis, cholangiocarcinoma, cogenital cholesochal cyst, primary sclerosing cholangitis and extraductal pressed diseases such as pancreatic cancer, metastaisis lymph node and so on. Otherwise, there were the false positive and false negative cases in our study. A case with dead ascaris in common bile duct and a case with intrahepatic cholangiocarcinoma in the left liver were all misdi-agnoses by MRCP. 2 cases with tiny choledocholithiasis were maldiagnosed by MRCP. MRCP in 2 cases with acute pancreatitis appeared' snow flower' sign adjacent to the biliary duct diliatated and indicated local collection fluid after the posterior abdominal menbrane. MRI could compensate for the shortcoming that MRCP cann't provide the extraduclal information. .Conclusion MRCP combined with MRT has an important value in the clinical diagnosis and treatment of pancreaticobiliary diseases. In paticular, under the circumstances of unclear diagnsis by B-mode ultrasound or CT to the postoperative patients with biliary diseases, invasive MRCP should become a first election tool.