胰头癌的MRCP特异征象的临床意义

目的探讨胰头癌MRCP的特异征象及其病理和临床意义。方法经手术病理证实35例胰头癌病例,术前均行MRCP检查,扫描序列包括SE序列T1W I、FSE序列T2W I、T2W I FS、MRCP冠状位扫描成像。结果本组35例胰头癌100%出现了MRCP的特异征象,其中C1 P1型为31例,C2 P1型和C2 P2型各2例。MRCP所显示的胰头癌体积均大于切除的病理标本。结论胰头癌的MRCP具有特异性征象。     

MRCP诊断胆总管癌的临床应用

目的探讨磁共振胰胆管成像(MRCP)对胆总管癌的诊断价值。方法对39例手术病理证实的胆总管癌病人术前进行了MRCP检查。结果39例胆总管癌术前MRCP均获得了具有诊断价值的MRCP图像。MRCP准确地显示了手术病理证实的胆总管癌的梗阻部位(39/39,100%)。MRCP对胆总管癌的诊断准确率为97%(38/39)。结论MRCP能清楚地显示胆总管癌的准确部位,并能对之做出准确的诊断。     

小胰头癌的CT诊断

目的：探讨小胰头癌在动态增强ＣＴ及螺旋ＣＴ双期增强扫描图上的ＣＴ表现。材料与方法：１０例经手术病理证实的小胰头癌患者，其中５例行动态增强ＣＴ扫描，另５例行螺旋ＣＴ双期增强扫描，动态增强ＣＴ扫描方法为；造影剂总量为８０～１００ｍｌ，行团注法，注射造影剂后２０ｓ，开始作胰头部层厚，间隔各５ｍｍ的动态扫描，螺旋ＣＴ双期扫描为：造影剂总量９０ｍｌ，速率３ｍｌ／ｓ，动脉期扫描为注射造影剂３０ｓ后行胰头部螺旋     

早期胰头癌的CT诊断

早期胰头癌又称小胰头癌，系指肿瘤直径≤2．0cm。本文搜集了经临床或手术、病理证实的16例小胰头癌资料，探讨其螺旋CT诊断价值。     

磁共振DWI并3D-VIBE序列对胰头慢性胰腺炎与胰头癌的鉴别诊断

目的探讨磁共振DW（I弥散加权成像）并3D-VIBE（三维梯度回波容积内插法）序列在胰头慢性胰腺炎与胰头癌鉴别诊断中的应用价值。方法 17例经临床、手术和病理证实的胰头疾病患者（胰头慢性胰腺炎4例,胰头癌13例）,分别行常规MRI检查、DWI、3D-VIBE序列平扫及动态增强扫描,对所获得的图像资料主要观测以下内容：肿块形态学特点,DWI肿块信号特征,肿块多期强化特征,胰管、胆管的改变,胰周血管显示情况,胰周器官受累情况及有无远处转移病灶等。结果 DWI肿块的信号特征：三组不同高b值（400、600、800s/mm3）的图像均显示胰头慢性胰腺炎呈较高信号,且信号近似于胰体、尾组织信号;胰头癌肿块信号明显高于正常胰腺组织信号者。3D-VIBE序列胰腺肿块强化特征分析结果：胰头慢性胰腺炎组中胰头部肿块动脉期几乎无强化,其强化程度明显低于正常胰腺组织,门脉期、延迟期肿块逐渐强化;而胰头癌组中胰头部肿块动脉期强化程度低于正常胰腺组织,门脉期、延迟期肿块强化效应逐渐减退。结论 DWI结合3D-VIBE动态增强扫描技术能较全面的显示胰头肿块的影像学特征,有助于胰头慢性胰腺炎与胰头癌的鉴别诊断。     

螺旋CT双期增强扫描在胰头癌检查中的临床应用和价值

螺旋ＣＴ双期增强扫描在胰头癌检查中的临床应用和价值曾蒙苏严福华周康荣以往胰头癌诊断，薄层动态增强ＣＴ扫描被认为是最佳的影像诊断技术［１，２］。但是，由于仍受到扫描速度的限制，其对胰头癌检出仍存在一定的困难。螺旋ＣＴ的出现极大地提高了扫描速度，因此，有...     

经动脉介入栓塞治疗胰头癌临床观察(附13例报告)

目的 探讨介入动脉栓塞治疗中晚期胰头癌的疗效.方法对13例胰头癌患者进行胰十二指肠动脉造影后,超选入肿瘤供血动脉灌注健择1000 mg,然后用健择200 mg和10 ml碘化油混悬液进行栓塞,4周后行CT扫描评价疗效.结果所有患者临床症状明显减轻,肿块明显缩小.结论 动脉栓塞治疗胰头癌有较好的疗效,是目前临床治疗胰头癌的可行有效方法之一.     

MRCP对诊断良恶性胆道梗阻的临床应用

目的 评价磁共振胰胆管成像(MRCP)对良恶性胆管梗阻的诊断价值。方法25例经病理证实的良恶性胆道梗阻包括胆囊及胆道结石10例,单纯胆囊结石3例,胆总管囊肿合并结石1例,壶腹及胰头癌6例,肝门癌3例,以及胆囊癌2例的MRCP表现进行了回顾性分析。MRCP检查是以PHILIPS GYROSCAN NT 1．0磁共振成像仪并用3D-FSE序列和常规SE序列进行的。结果在所有病人中成功地进行了MRCP检查。其表现随病变性质与部位不同而异,如肝内胆管明显扩张且呈软藤状见于肝门癌。胆总管横行截断,断端形态规则见于胆管上段腺癌。胆总管明显增宽呈壶腹状,胆囊明显增大见于胆总管囊肿。结论MRCP应成为诊断良恶性胆道梗阻的推荐方法。     

Suspected chronic pancreatitis with normal MRCP: findings on MRI in correlation with secretin MRCP

PURPOSE: To review pancreatic MRI findings and their relationship with estimated pancreatic exocrine function on secretin-stimulated MR cholangiopancreatography (S-MRCP) in patients with clinically suspected chronic pancreatitis and normal baseline MRCP findings. MATERIALS AND METHODS: MRI findings of 26 patients with normal pancreatic duct diameter and without side branch ectasia on MRCP were evaluated. A single radiologist assessed pancreatic size, pancreatic signal intensity ratio (SIR), and arterial enhancement ratio (A/V) at head, body, and tail of the pancreas on T(1)-weighted fat-suppressed and serial contrast-enhanced images at a single session. Combined findings were graded with a composite score. Serial S-MRCP was performed at the same session with standard MRI. Correlation and differences between MRI findings and associated grade of duodenal filling (DF) or the degree of pancreatic duct caliber change (PDC) were analyzed. RESULTS: Seven patients revealed normal and 19 patients abnormal MRI findings. Significant correlation was present between the degree of DF and mean values of pancreatic size (r = 0.748), SIR (r = 0.610), A/V (r = 0.466), composite score (r = 0.833), and PDC (r = 0.554) separately. PDC correlated with SIR (r = 0.413) and composite score (r = 0.452), but not with A/V or pancreatic size. Significant differences were present between normal and abnormal DF grades in terms of mean values of associated findings of size (P = 0.001), SIR (P = 0.008), A/V (P = 0.019), and PDC (P = 0.001). CONCLUSION: Patients with clinically suspected chronic pancreatitis and normal MRCP findings may have a spectrum of MRI findings that correlate with the estimated pancreatic exocrine insufficiency on S-MRCP with the increasing number of combined findings.     

磁共振胰胆管成像对胰腺分裂诊断价值的评估

目的 评价磁共振胰胆管成像(MRCP)对胰管的显示能力和对胰腺分裂的诊断价值。资料与方法 回顾108例行MRCP检查的图像，分别观察各序列图像对胰管的显示能力和胰腺分裂在MRCP图像上的表现。结果 108例的MRCP图像，于冠状位或斜冠状位厚层TSET2WI图像有70．4％(76／108)的胰管全程显示清晰；于HASTE序列薄层冠状位或斜冠状位图像有76．9％(83／108)的胰管全程显示清晰；HASTE序列薄层横断位图像有63％(68／108)的胰管全程显示清晰；综合3个序列图像有85．2％(92／108)病例胰管全程显示清晰；99．1％(107／108)的病例胰管大部分显示清晰；冠状位薄层图像对胰头部胰管显示较好。在108例中11．1％(12／108)的病例诊断为胰腺分裂；其中5例诊断为不完全性胰腺分裂。12例胰腺分裂中有1例因胰腺分裂合并有反复发作性腹痛。结论 MRCP作为一种无创伤性检查，对胰管有很好的显示能力；对胰腺分裂可作出明确诊断，对胰腺分裂合并有不明原因反复发作性腹痛或急性胰腺炎反复发作病例的治疗有指导意义。     

胰腺癌CT误诊分析

目的　分析胰腺癌CT误诊和漏诊原因 ,提高对胰腺癌CT诊断和鉴别诊断能力。方法　对 17例术前误诊的胰腺癌病例进行回顾性分析。CT检查采用螺旋CT动脉期和静脉期扫描 ,层厚 3～ 5mm。结果　 17例胰腺癌中 ,术前CT误诊为慢性胰腺炎 4例 ,慢性胰腺炎伴假性囊肿 2例 ,胰腺假性囊肿 1例 ,壶腹部癌 2例 ,十二指肠恶性肿瘤 2例 ,胃癌 2例 ,CT未见明确肿块而漏诊 4例。术后诊断胰头癌 15例 ,胰体部癌 1例 ,胰尾部癌 1例。病理诊断胰腺腺癌 15例 ,胰腺癌伴慢性胰腺炎 1例 ,导管内乳头状癌 1例。结论　注意螺旋CT扫描方法 ,仔细阅片 ,全面分析 ,能减少CT对胰腺癌的误诊率和漏诊率     

胰头静脉弓的16层CT研究

目的探讨16层CT的各种血管成像方法对胰头静脉弓的正常表现及显示率方法对40例非腹部疾病患者行胰腺静脉期扫描,使用轴位图像、薄层最大密度投影(TSMIP)和容积再现(VR)图像分别评价胰头静脉弓的表现及显示率结果轴位图像、TSMIP和VR显示胃网膜右静脉均为100%,胃结肠干均为80%,右结肠上静脉分别为100%、87.5%、80%;胰十二指肠上后静脉分别为92.5%、65%、40%;胰十二指肠上前静脉分别为92.5%、62.5%、45%结论使用16层CT,联合轴位、TSMIP和VR图像可以清楚显示胰头静脉弓     

MRI and S‐MRCP findings in patients with suspected chronic pancreatitis: Correlation with endoscopic pancreatic function testing (ePFT)

Purpose:

To review magnetic resonance imaging (MRI) and secretin stimulated magnetic resonance cholangiopancreatography (S‐MRCP) findings of patients with suspected chronic pancreatitis and compare them with endoscopic pancreatic function testing (ePFT).

Materials and Methods:

MRI and S‐MRCP findings of 36 patients with clinically suspected chronic pancreatitis were reviewed. Baseline ductal changes, duodenal filling grades, and pancreatic duct caliber change (PDC) on S‐MRCP, mean values of pancreatic anteroposterior (AP) diameter, signal intensity ratio (SIR) between pancreas and the spleen on T1‐weighted fat saturated images, and arterial to venous (A/V) enhancement ratios were compared between groups of normal and abnormal pancreatic exocrine function determined by ePFT.

Results:

All patients (n = 24) with normal ePFT (HCO₃ >80 mEq/L) had grade 3 normal duodenal filling. Patients with abnormal ePFT (HCO₃ <80 mEq/L) (n = 12) had grade 1 (n = 1) and grade 2 (n = 11) diminished duodenal filling (P < 0.0001). PDC was 1.51 in the normal ePFT group versus 1.27 in the abnormal ePFT group (P = 0.01). No significant differences were found in terms of mean pancreatic AP diameter (21.8 vs. 19.8 cm), SIR (1.59 vs. 1.44), and A/V (1.08 vs. 1.01) between groups of normal/abnormal pancreatic exocrine function.

Conclusion:

Despite discrepancies between pancreatic exocrine function and the findings on standard MRI/MRCP, the S‐MRCP findings are comparable to ePFT in the evaluation of chronic pancreatitis. J. Magn. Reson. Imaging 2010;31:601–606. © 2010 Wiley‐Liss, Inc.