MR胆管造影对阻塞性黄疸的诊断价值

目的:随着MR扫描技术的发展,利用水成象原理的MR胆管造影(MR Cholangiography,简称MRC)以其无创伤性和多层面成象的特点,为临床诊断阻塞性黄疸提供又一有效的影像手段。材料与方法:阻塞性黄疸病人共30例均为手术病理证实或临床治疗随访证实。其中良性13例,恶性17例。约1/3为急性阻塞性黄疸病人。全部病人均有术前的MR和MRC扫描检查。扫描设备为荷兰Philips公司生产的GYROSCAN T5-Ⅱ超导型磁共振扫描装置,磁场强度0.5T。MR常规扫描SE序列T_1W、T_2W横断面和冠状/矢状面扫描。MRC的扫描参数是FSE序列,TR/TE 4000/120ms,层厚4mm,层间距1mm,扫描方向是向下、背侧倾斜15度,向右倾斜30度的斜冠状位,采用表面线圈。扫描结束后用MIP进行以躯体长轴为轴心的冠状面多角度重建。结果:1.在决定肝内/外的胆管系统扩张,以及对阻塞平面的定位方面,MR扫描和MRC均做出了正确的判断。由于MRC的重建图象和原始图象能较清楚地显示阻塞端的形态,特别是腔内和管壁的情况,有助于判别良恶性。2.恶性阻塞性黄疸的胆总管阻塞端表现为扩张的胆总管或肝管突然中断、不规则偏心性狭窄或鼠尾状向心性变窄。3.良性阻塞性黄疸的特点是阻塞狭窄端圆钝,管壁光滑、增厚,无明确壁结节或周围软组织肿块。胆总管结石者可见在胆总管狭窄处腔内无

MR Cholangiography in Obstructive Jaundice Diseases

Purpose: MR cholangiography (MRC) is a new non-invasive imaging technique. Our study is to evaluate the MRC in display the obstructive level, the lesions of the common bile duct and/or intrahepatic duct in jaundice patients. Materials and Methods: 30 cases of jaundice patient, including carcinoma of biliary duct or pancreas, cholelithes, congenital choledochocyst, and post-operation changes, were evaluated by MRC. The parameters for MRC were T2W oblique coronal scan, TR/TE= 1800 -4000ms/120 -250ms, slice thickness 4mm, gap- 1mm. The pathological changes were confirmed by operation or other imaging methods. Results: The commom bile duct dilation, the obstructive level and shape were showed clearly in all cases. In carcinoma patients, the ducts displayed stricture or complete obstruction. The calculi blocking the dilated bile duct end showed very well in the cholelithes cases. For the congenital children, the cyst-like changes in different section were decided easily. Conclusion: MRC is an effective and non-invasive method to help the diagnosis of jaudice patients.