3.0T磁共振钆塞酸二钠磁共振胆管造影术在胆管疾病中应用

目的探讨3.0T磁共振钆塞酸二钠(Gd-EOB-DTPA)磁共振胆管造影术(MRC)在胆管疾病中的诊断价值。方法选取2016年7—12月解放军309医院收治的20例患胆道梗阻或其他病变需行Gd-EOB-DTPA MRC检查的患者,采用3.0T超导磁共振扫描仪,对所有20例患者行常规上腹部平扫+磁共振胰胆管造影(MRCP)+Gd-EOB-DTPA动态增强扫描,以及肝胆特异期、T1容积内插体部检查(VIBE)冠状位+轴位扫描,并将冠状位图像进行最大密度投影(MIP)重建,获得胆管树图像。对各序列的影像学特征做出诊断,并与穿刺、手术病理、内镜下逆行胰胆管造影术及相关临床资料进行对照。结果本组20例患者中,胆管解剖变异者7例。其中,胆囊管经胆总管前方汇入胆总管左侧壁1例,经胆总管后方汇入胆总管左侧壁3例,胆囊管开口于肝外胆管下1/3处2例,胆囊管汇入右肝管1例。胆管梗阻11例,其中,完全性梗阻8例(肝门部胆管恶性占位5例、胆总管恶性占位1例、胆总管下端结石1例,胆总管周围淋巴结转移1例);部分梗阻3例(胰头占位1例,胆总管结石1例,胃窦癌侵及胆总管1例)。胆漏2例。硬化性胆管炎1例。其中,1例患者同时有胆漏及胆囊管汇入右肝管变异。结论 Gd-EOB-DTPA MRC检查能够直接显示肝内外胆管系统解剖结构以及胆管通畅情况,能为胆管疾病的诊断提供更多的信息,可以进一步应用于胆管疾病的检查。

3.0T magnetic resonance Gd-EOB-DTPA MRC application value in bile duct diseases

Objective To investigate the application value of 3.0T magnetic resonance Gadolinium plug acid disodium salt (Gd-EOB-DTPA) MRC in bile duct diseases.Methods A retrospective study was performed on 20 patients with biliary obstruction or other lesions from July to December 2016.Patients who required Gd-EOB-DTPA MRC examination were detected by 3.0T superconducting magnetic resonance imaging(MRI) device,each patient underwent abdominal scan plus MRCP plus Gd-EOB-DTPA dynamic enhanced scan,and liver specific period,T1VIBE coronary position plus axis scanning,and coronary position was reconstructed to get the biliary tree by image MIP.The characteristics of sequence image was diagnosed,and was compared with biopsy,surgical pathology,endoscopic retrograde cholangiopancreatography(ERCP) and related clinical data.Results In the total of 20 patients,bile duct anatomic variation in 7 cases,including cystic duct after common bile duct into the common bile duct in front left behind the wall in 1 case,through the common bile duct into the common bile duct left wall in 3 cases,cystic duct openings in the extrahepatic bile duct under a third place in 2 cases and cystic duct into the right hepatic duct in 1 case.The bile duct obstruction in 11 cases,including completeness obstruction in 8 cases (hepatic bile duct malignant placeholder portal vein in 5 cases,bile duct malignant placeholder in 1 case,the lower common bile duct stones in 1 case and common bile duct surrounding lymph node metastasis in 1 case);the partial obstruction in 3 cases (pancreatic head placeholder in 1 case,common bile duct calculi in 1 case,distal gastric cancer invasion and bravery manager in 1 case).The fistula in 2 cases and sclerosing cholangitis in 1 case.One case had bile leakage and cystic duct into the right hepatic duct variation.Conclusion Gd-EOB-DTPA MRC examination can directly display system anatomic structure of bile duct of liver inside and outside and bile duct unobstructed,can provide more information for the diagnosis of biliary diseases,which can be further applied in the bile duct diseases.