MRI结合MRCP诊断肝门区胆管癌(附39例分析)

目的:探讨肝门区胆管癌MRI、MRCP表现及诊断价值。方法:分析总结了39例肝门区胆管癌的MRI和MRCP表现,并与手术病理结果对比。结果:39例肝门区胆管癌中,MRI均显示肝内胆管不同程度的扩张,其中肝门区软组织肿块34例,增强扫描均呈不均匀性强化,胆管壁不规则增厚呈鼠尾状5例。MRCP显示病变部位胆管中断,梗阻近端形态截断状或圆锥状17例,鸟嘴状或鼠尾状27例,杯口状2例。结论:MRI结合MRCP是检查肝门区胆管癌的有效手段。     

MRI及MRCP在肝门胆管癌和肝门部良性胆道梗阻中的鉴别价值

目的 探讨肝门胆管癌和肝门部良性胆道梗阻的MRI、MRCP鉴别诊断价值.方法 回顾性分析经手术病理或临床证实的13例肝门胆管癌和20例肝门部良性胆道梗阻的MRI、MRCP表现,并与临床手术、病理进行对照.结果 13例肝门胆管癌中显示浸润型9例,T2 WI显示管壁增厚;肿块型4例,肝门部显示类圆形结节,T1WI呈稍低信号,T2 WI呈稍高信号.MRCP显示肝门胆管梗阻端的形态特征,截断状5例(肝门区呈空虚状改变),鼠尾状8例.肝内胆管呈树枝状和软藤状扩张.20例肝门部良性胆道狭窄的病例中,胆管结石13例,肝门部胆管炎症2例,术后狭窄5例.左肝管狭窄4例,右肝管狭窄1例,汇合部狭窄5例,肝总管狭窄10例(包括Mirizzi综合征4例),肝门区均未见软组织结节.MRCP显示肝门区胆管不完全性梗阻,呈漏斗状狭窄,边缘光滑.肝内胆管呈枯枝状扩张3例,树枝状扩张17例.结论 常规MRI和MRCP结合有助于肝门部胆道梗阻的定位诊断.肝门胆管癌和肝门部良性胆道梗阻在MRI、MRCP上存在多种不同征象可鉴别诊断.     

恶性胆道梗阻的磁共振胰胆管造影诊断

目的 评价磁共振胰胆管造影（MRCP）对胆道恶性梗阻性疾病的诊断价值。材料与方法 43例恶性胆道梗阻患者（胆管癌15例,壶腹癌4例,胰头癌10例,转移性癌10例,原发性肝癌4例）行MRCP检查,结合PTC、ERCP检查、手术、病理结果、临床资料进行综合分析。结果 43例患者MRCP检查均一次成功,胆管及扩张胰管显示满意,定位诊断准确率为100％、定性准确率为83．7％。肝门区癌肿MRCP表现为肝门区不规则或类圆信号缺损,肝内胆管扩张以肝门区为中心呈“枯枝”状或“蟹足”样扩张;肝外胆管癌胆管断端呈模形或“鸟嘴”样截断;壶腹癌胆管断端呈横形、“鸟嘴”样或“鼠尾”状截断;胰头癌胆管断端呈“鸟嘴”样或“鼠尾”状截断,90％（9／10）伴“双管征”;转移性癌肿MRCP表现与转移部位有关;转移至肝门附近与肝门区癌肿相似,肝外转移者与相应部位胆管癌、胰头癌相似,常规MRI可见明显转移肿块或淋巴结。结论 MRCP是胆道恶性梗塞影像学检查的有效补充手段,可为恶性胆胰肿瘤术前可切除性提供评价,对不可切除的癌肿行介入治疗提供参考。     

肝门部胆管癌的CT和MRI诊断

目的：评价和比较CT和MRI在肝门部胆管癌的分型和诊断中的作用。方法：回顾性分析30例肝门部胆管癌的MRI平扫、增强及MRCP表现，其中13例同时作CT检查，比较两者对肝门部胆管癌的显示能力，并与手术、病理对照。结果：肝门部胆管癌CT与MRI均表现为肝内胆管不同程度的扩张，肝门部见软组织肿块，MRI T1WI呈稍低信号，T2WI呈稍高信号，MRCP表现为肝门部胆管梗阻。对肿块型肝门部胆管癌MRI和CT显示均较好，对浸润型肝门部胆管癌MRI较CT显示好。结论：MRI和CT是检查肝门部胆管癌的有效手段。MRI及MRCP在显示浸润型肝门部胆管癌较CT优越。     

多种 MRI 技术诊断肝门区梗阻性黄疸的价值分析

目的：探讨多种MRI成像技术诊断肝门区梗阻性黄疸的价值。方法：肝门区梗阻性黄疸27例，分别采用FLASH T1WI、FSE T2WI、T1WI＋FS及T2WI＋FS、Gd-DTPA动态增强扫描等磁共振成像技术（MRI）和磁共振胰胆管造影（MRCP），分析其影像学特征。结果：恶性梗阻15例中，有肝门区软组织肿块13例，其MRCP胆管梗阻端多突然中断、鼠尾状狭窄和（或）腔内不均匀充盈缺损信号，肝内胆管多出现中重度“软藤状”扩张；良性梗阻12例中，有肝门区软组织肿块1例，其MRCP胆管梗阻端多为杯口状、细线状或腔内略呈类圆形充盈缺损信号，肝内肝管呈轻中度扩张。结论：多种MRI技术结合MRCP，对肝门区梗阻性黄疸的定位、定性具有重要诊断价值。     

肝门部胆管癌影像学诊断

本文对５６例经手术和病理证实的肝门部胆管癌进行了影像学回顾性分析，直接法胆道造影（ＤＣ）表现征象可分为胆道梗阻、狭窄、息肉样变和右肝管狭窄伴左肝管梗阻。ＵＳ显示肝内胆管的扩张，肝门区低回声占位，胆管内低回声肿块，门静脉癌栓。ＣＴ可表现，肝内胆管扩张，肝门区软组织密度肿块，肝门区肿块有增强，胆囊变小或萎缩，左肝萎缩和右肝增大，作者认为：ＤＣ加上ＵＳ或ＣＴ是诊断肝门区胆管癌的首选方法。     

肝外胆管癌的CT诊断

目的：加深对肝外胆管癌CT表现的认识，探索CT对肝外胆管癌的检查方法。方法：分析21例经手术病理或活检证实的肝外胆管癌的CT表现，其中肝门部胆管癌3例，胆总管癌18例。12例梗阻端行薄层放大增强扫描。结果：3例肝门胆管癌肝内胆管均扩张，2例肝门区可见肿块。18例胆总管癌均见量总管突然中断中断或变形，3例梗阻近端胆管壁不均匀增厚，5例腔内见软组织结节影，5例出现明显侵犯到腔外的软组织肿块形。结论：CT薄层大增强扫描能有效地显示梗阻端形态，是诊断肝外胆管癌有效而较可靠的方法。     

高位胆道梗阻的CT表现及其诊断价值

目的 探讨螺旋CT对高位胆道梗阻的诊断价值。方法 回顾性分析经手术病理或临床资料证实的15例高位胆道梗阻CT表现。结果 15例中，肝内胆管癌1例，肝门区胆管癌6例，肝门区肝癌3例，肝门转移癌2例，硬化性胆管炎2例。肝内胆管结石1例，各有其CT特征，结论 螺旋CT扫描不仅能准确确定梗阻的平面，而且能对疾病做出定性诊断。     

磁共振胰胆管成像对肝外胆管梗阻的诊断价值(附35例分析)

目的：探讨磁共振胰胆管成像对肝外胆管梗阻的诊断价值。方法：对35例肝外胆管梗阻性疾病行MRCP检查，MRCP采用呼吸门控重T2 FSE序列，把资源图像行MIP和／或MPR法重建。全部病例与临床诊断或手术和病理对照分析。结果：全部35例MRCP检查均一次成功，且胰胆管显示满意。经手术病理证实或临床综合诊断，恶性胆管梗阻28例(胆管癌14例，胰头癌11例，壶腹癌2例，转移癌1例)，胆管结石7例。MRCP对肝外胆管梗阻程度的判断和定位诊断准确率为100％，总定性诊断准确率为88．6％。结论：MRCP对肝外胆管梗阻定位诊断准确，结合资源图像和MR平扫，对肝外胆管结石和恶性梗阻的定性诊断均有较高的准确性。     

肝门区胆管癌的CT表现与病理对照（附15例分析）

目的：探讨肝门区胆管癌的CT影像表现与诊断价值。方法：搜集15例经手术和病理证实的肝门区胆管癌,分析肝门区胆管癌CT影像特征和病理基础。结果：6例CT平扫表现为肝门区低密度软组织肿块,9例表现为肝门区胆管壁不规则增厚,动态增强后11例有延迟强化,CT值增加15～30HU。对照CT表现与手术所见,CT显示肝脏、肝门区动脉、门静脉、胆囊、肝门区淋巴结转移、腹膜后淋巴结浸润或转移;其它神经、脂肪受浸、腹膜种植在CT上均无明确显示。结论：肝门区胆管壁不规则增厚或软组织肿块伴肝内胆管扩张是肝门区胆管癌的CT基本影像表现,CT是检出和识别肝门区胆管癌的重要方法,但在判断肿瘤周围浸润的程度时仍有一定局限性。     

肝外胆管细胞癌的CT诊断

目的:分析肝外胆管细胞癌的CT表现,探讨其诊断价值。材料和方法:23例病理证实的肝外胆管癌均行螺旋CT动态增强检查和ERCP检查,分析其影像表现和诊断准确性。结果:CT诊断符合率78.3%(18/23),均表现为特征软组织肿块(直接征象)和肝内胆管及胆总管扩张(间接征象)。CT同时提供了较好的肿瘤分期诊断。ERCP诊断符合率91.3%(21/23),表现为肝内胆管均呈不同程度的扩张,肝外胆管狭窄、截断。CT结合ERCP后全部诊断正确,并提供详细信息。结论:肝外胆管细胞癌的螺旋CT检查有较好的诊断,结合ERCP可以获得更高的诊断准确率。     

静脉注射联合口服钆喷酸葡胺磁共振胆胰管成像在低场强MR的应用

目的分析口服稀释静脉用钆喷酸葡胺溶液作为低场强磁共振胃肠道阴性对比剂及联合静脉注射钆喷酸葡胺磁共振胆胰管成像(MRCP)在低场MR中用于显示胆胰管及疾病的能力。方法 30例临床可疑有胆胰管病变的患者,均有不同程度胆系梗阻、腹痛、不同程度皮肤或巩膜黄染等,部分有腹部肿块,均行MR平扫、Gd-DTPA(钆喷酸葡胺)强化检查,部分同时行超声及CT检查。结果 30例受检者均能清楚显示胆胰管树,并能清晰显示病变位置,其中18例发现肝内胆管占位,10例发现肝内胆管、肝外胆管及(或)胆囊结石,2例胰头占位。结论口服钆喷酸葡胺溶液可抑制胃及十二指肠内潴留液的高信号以及胆胰管树背景的小血管信号,改善MRCP图像的质量,结合肝胆MR平扫、强化应用具有较高的肝内、外胆管显示率及肝内、外胆管病变的显示能力,能为胆胰管病变的诊断及鉴别诊断提供更多帮助。     

The role of 99mTc mebrofenin hepatobiliary scanning in predicting common bile duct stones in patients with gallstone disease

BACKGROUND: A dilated common bile duct and/or elevated serum alkaline phosphatase, raises a suspicion of bile duct stone(s) in patients with gallstones. Cholangiography, either endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopancreatography (MRCP), is the best method for diagnosing bile duct stones. ERCP has the disadvantage of being invasive, and there is a risk of complications; while MRCP is costly and is not widely available. AIM: The objective of the present study was to evaluate the role of hepatobiliary nuclear scanning in diagnosing bile duct stones. METHODS: Twenty-five patients with suspected common bile duct (CBD) stones underwent hepatobiliary scintigraphy. The results of scintigraphy were compared with cholangiograms obtained by ERCP in 11 patients and MRCP in 14 patients, considering MRCP/ERCP as the 'gold standard'. RESULTS: Scintigraphy showed features suggestive of CBD stones in 11 of the 25 patients. The results of ERCP/MRCP confirmed that eight of them had stones. Scintigraphy showed no features of CBD stones in the remaining 14 patients. ERCP/MRCP showed CBD stones in two of these 14 patients. Thus, scintigraphy had a sensitivity of 80% and a specificity of 80%. CONCLUSION: We conclude that scintigraphy has good sensitivity and specificity in predicting CBD stones in patients with gallstone disease and a dilated CBD.     

螺旋CT在先天性胆管扩张症中的诊断价值

目的探讨螺旋CT在先天性胆管扩张症的诊断价值。方法回顾性分析6例先天性胆管扩张症息者的CT资料，并和US、ERCP和手术结果进行对比分析。结果所有病例的轴位、MPR和三维图像很好的显示肝内外胆管的解剖形态，清楚地显示扩张的肝内外胆管。其中Ⅰ型单纯性胆总管扩张3倒。Ⅳ肝内外胆管均扩张2例，Ⅴ型肝内胆管扩张（Caroli’s病）1例。结论螺旋CT可以很好的显示扩张的肝内外胆管的形态、部位以及周围组织结构。能为临床提供有价值的诊断信息，为手术提供可靠的依据。     

肝外胆管癌X线和超声诊断的探讨

本文归纳了30例肝外胆管癌用PTC、ERCP、术中或术后“T”形管造影的X线征象:完全性阻塞端形态有杯口、截断、钝圆、尖削、不规则等;不完全阻塞端有菜花状、不规则、局限性狭窄等。低张钡餐检查对远段胆道病变,仍不失为简易有效的手段。US对肝内胆管扩张和结石的准确率很高,但胆总管下段病变受到限制。为了合理利用各种检查方法,设计了以US为第一步的筛选程序,在CT尚不普及的情况下是切实可行的。     

MRCP 3D FRFSE系列对良恶性胰胆管梗阻的诊断价值

目的探讨三维快速恢复快速回波脉冲系列磁共振胰胆管水成像(MRCP 3D FRFSE)对良恶性胰胆管梗阻的临床应用价值。方法对106例临床疑有胰胆管梗阻患者行MRCP 3D FRFSE系列检查,2位高年资放射科医师前瞻性分析图像,结果与手术病理或临床随访结果比较。结果106例MRCP检查均一次性成功,肝内外胆管显示率为100%,主胰管显示率为93.4%,其中80例良性梗阻包括肝内外胆管结石66例,乳头炎6例,十二指肠降段憩室炎2例,十二指肠腺瘤样增生1例,慢性胰腺炎5例;26例恶性梗阻包括肝外胆管癌9例,壶腹癌5例,胆囊癌4例,胰头癌8例。MRCP对胰胆管梗阻的定位诊断准确率为100%,在区分良恶性梗阻中,敏感性92.3%,特异性96.3%,准确性95.3%。结论3D FRFSE系列的MRCP是区分良恶性胰胆道梗阻病变较为理想的技术,在临床上有较大的应用价值。     

The diagnostic accuracy of magnetic resonance cholangiopancreatography and ultrasound compared with direct cholangiography in the detection of choledocholithiasis.

AIM: To determine the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) and ultrasound (US) in the diagnosis of choledocholithiasis in a large group of patients with bile duct stones confirmed at direct cholangiography. Also, to compare bile duct stones confirmed at direct cholangiography. Also, to compare bile duct stone characteristics using the three different investigations, endoscopic retrograde cholangiopancreatography (ERCP), MRCP and US. MATERIALS AND METHODS: 191 patients (M:F, 76:115; mean age, 66 years; range, 24-92 years) were investigated by direct cholangiography, MRCP and US. Their final diagnosis as determined at direct cholangiography were choledocholithiasis (n = 34), strictures (n = 47) and normal ducts (n = 110). The direct cholangiographic methods used for diagnosis of choledocholithiasis were ERCP (n = 29), intraoperative cholangiography (n = 3) and percutaneous transhepatic cholangiography (n = 2). The bile duct stone characteristics were compared using ERCP, MRCP and US in the 29 patients in whom stones were exclusively diagnosed by ERCP. RESULTS: Compared with the final diagnosis, MRCP had a sensitivity, specificity and diagnostic accuracy of 91%, 98% and 97%, respectively, in the diagnosis of choledocholithiasis. MRCP resulted in three false-negative and three false-positive findings, four of which occurred due to confusion with lesions at the ampulla. US had a sensitivity, specificity and diagnostic accuracy of 38%, 100% and 89%, respectively, in the diagnosis of choledocholithiasis. ERCP diagnosed more stones and the stones were more proximally distributed within the bile duct at ERCP when compared with MRCP. CONCLUSION: MRCP has a high diagnostic accuracy (97%), similar to that at direct cholangiography, in the diagnosis of choloedocholithiasis. It has the potential to replace diagnostic ERCP and select patients with choledocholithiasis for therapeutic ERCP.     

Diagnosis of intrahepatic stones: superiority of MR cholangiopancreatography over endoscopic retrograde cholangiopancreatography

OBJECTIVE: The purpose of this study was to compare the efficacy of MR cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) for the diagnosis of intrahepatic stones. MATERIALS AND METHODS: Of the 318 patients who underwent MRCP examinations at our institution during an 18-month period, we identified 49 patients who subsequently underwent surgery or cholangioscopic stone removal with proof of intrahepatic stones. Thirty-four of these patients also underwent ERCP; they made up our study population. All images were interpreted for the presence of bile duct stones: MRCP images were interpreted independently by two reviewers, and ERCP studies were interpreted by one reviewer who was unaware of the MRCP findings. RESULTS: The sensitivity and specificity of MRCP for detecting intrahepatic stones were 97% and 93%, respectively, whereas those of ERCP were 59% and 97%, respectively. MRCP showed a significantly higher sensitivity than ERCP in the diagnosis of intrahepatic stones (p < 0.001). We found no significant difference between MRCP and ERCP in sensitivity or specificity for detecting calculi in the common duct or gallbladder. CONCLUSION: MRCP is a more effective diagnostic method than ERCP for the evaluation of intrahepatic stones.     

肝细胞癌合并胆管癌栓的影像表现

目的 探讨胆管癌栓的影像表现,以提高影像诊断水平.方法 回顾性分析经手术病理证实的肝细胞癌(HCC)胆管癌栓13例患者资料,其中3例进行了CT和MR检查,2例仅行CT检查,8例仅行MR检查,7例进行了MR胰胆管成像检查,13例均进行了超声检查.采用四格表Fisher 确切概率检验方法比较超声与CT、MR诊断HCC胆管癌栓的准确性.结果 13例HCC肿瘤及胆管癌栓均在CT或MRI上显示.4例胆管癌栓在CT上表现为胆管内软组织块影,动脉期可见癌栓轻度增强,癌栓远端胆管扩张.11例胆管癌栓在T1 WI上均呈稍低信号,T2 WI为稍高信号,增强后可见轻、中度强化.MR胰胆管成像上胆管癌栓表现为:胆管阻塞中断、狭窄或不规则充盈缺损伴有梗阻上方胆管扩张,胆管突然截断或呈"鼠尾"状(5例);肝内胆管扩张,癌栓充满整个胆总管.胆总管不显示(2例).超声检查准确诊断胆管癌栓7例,误、漏诊6例.CT、MRI准确诊断12例,误诊4例,超声与CT、MRI诊断胆管癌栓差异无统计学意义(P=0.270).结论 CT或MRI对诊断HCC合并胆管癌栓及明确癌栓范围有价值.     

恶性梗阻性黄疸的ERCP与CT对照分析

本文对比分析了８２例恶性梗阻性黄疸（包括胆管癌４５例，转移性癌２６例，胰头癌６例及壶腹周围癌５例）的ＥＲＣＰ与ＣＴ表现，主要发现：恶性胆管梗阻部位多位于肝外胆管近侧段；肝外胆管近侧段梗阻所致的肝内胆管重度扩张的发生率，远多于远侧段阻塞，在反映肝内胆管扩张程度、扩张范围方面ＣＴ优于ＥＲＣＰ，而显示病灶肿块直接征象方面ＥＲＣＰ优于ＣＴ。