同层动态磁共振胰胆管成像的临床研究

目的 :利用动态磁共振胰胆管成像 (MRCP)分别评价Oddi括约肌功能及口服果汁对改善胰管显示方面的作用。方法 :将 3 8例经临床或手术病理证实有胰胆管系统疾病的患者 ,分成三组 :A组 (n =15 )为有壶腹部周围的梗阻性病变伴胆道扩张 ;B组 (n =13 )为有壶腹部以上的梗阻性病变伴胆道扩张 ;C组 (n =10 )为未见明显梗阻性病变但有胆道扩张。各组分别摄取动态MRCP图像并观察括约肌舒张情况 ;19例正常志愿者 ,口服果汁 (Orange lemonjuice ,OLJ)前及口服果汁后 15、3 0、45、60、75、90min分别摄取动态MRP图像。结果 :3 8例患者MRCP图像上 ,胆总管远端出现乳头状 ,逐渐狭窄 ,平头状及倒杯口状 4种改变 ,其中倒杯口状改变仅出现于A组 ,与其它两组间差异有显著性意义 (P <0 .0 5 ) ;乳头状、逐渐狭窄及平头状改变 ,各组间差异无显著性意义。动态MRCP可反映括约肌段舒张频次 ,其在A组与其它两组间差异有显著性意义 (P <0 .0 5 )。正常人口服果汁后MRCP成像显示胰管管径增粗 ,管腔信号强度升高 ,体、尾部胰管的显示率提高。结论 :动态MRCP能很好地评价Oddi括约肌功能 ,提高对壶腹部病变的诊断准确性 ;果汁能促进胰腺外分泌 ,改善胰管显示。

Cliinical Study of Dynamic MR Cholangiopancreatography

Objective:To evaluate the function of Oddi's sphincter and the role of oral orange-lemon juice (OLJ) in improving the delineation of pancreatic duct using dynamic MRCP.Methods:Thirty-eight patients underwent dynamic MRCP and were divided into three groups.Group A (n=15),ampullary and periampullary obstructive lesions with dilatation of biliary duct;group B (n=13),supraampullary obstructive lesions with dilatation of biliary duct;group C (n=10),biliary dilatation without obvious obstructive lesions.Ninteen healthy volunteers were performed dynamic MRP before and 15,30,45,60,75,90 minutes after taking OLJ.Results:Four types were observed at the distal end of the biliary duct:papillary form,gradual narrowing,flat-form and reverse cupping form.There was significant difference between group A and other two groups in the average number of sphincteric segment relaxations of each person on the dynamic MRCP images.The reverse cupping form appeared only in group A.There was no significant defference in the other shapes between the three groups.After ingestion of OLJ there was better demonstration of the pancreatic duct. Conclusion:Dynamic MRCP can evaluate the function of Oddi's sphincter so that to increase the diagnostic accuracy.The orange-lemon juice can stimulate exocrine pancreatic secretion and improve the delineation of the pancreatic duct in MRCP.