The Preoperative Evaluation of Plain MR and Coronal LAVA Technique in Low Level Biliary Obstruction

目的 探讨磁共振平扫[包括磁共振胰胆管造影(MRCP)]及冠状面快速三维容积动态增强(liver acquisition with volume acceleration,LAVA)在低位胆管梗阻诊断中的应用价值.资料与方法 64例低位胆管梗阻患者进行MR平扫、MRCP及冠状面LAVA检查,并将检查结果按三种方法分组:(1)平扫(包括MRCP);(2)冠状面LAVA;(3)MR平扫+冠状面LAVA.对检查结果进行判读与分析,包括病变的定位及定性诊断,并与手术病理、经内镜逆行性胰胆管造影术(ERCP)或经皮肝内胆管造影术(PTC)结果对照,诊断结果进行McNemar检验,数据不足时采用精确概率法.结果 依据最终诊断结果将所有病例分为三组:(1)肿瘤性低位胆管梗阻;(2)除结石外良性低位胆管梗阻;(3)结石性低位胆管梗阻.第一组病例中三种方法的定位诊断符合率无统计学差异,而MR平扫的定性诊断符合率低于冠状面LAVA及MR平扫+冠状面LAVA两种方法(P值分别为0.039,0.021).第二组病例定位及定性诊断符合率无明显统计学差异.第三组冠状面LAVA诊断符合率低于其他两种方法(P=0.031).结论 冠状面LAVA对于肿瘤性低位胆管梗阻的定性诊断具有较大优势,MRCP在胆管梗阻疾病中,简便易行,可用于筛选检查,对于胆管结石的诊断有明显优势.     

MR冠状面LAVA技术在低位胆道梗阻中的应用价值

目的：探讨磁共振冠状面快速三维容积动态增强（liver acquisition with volume acceleration,LAVA）在低位胆道梗阻中的应用价值。方法：50例低位胆道梗阻患者（排除较明显胆道结石者）,进行MR平扫（包括MRCP）及冠状面LAVA检查,对检查结果进行判读与分析,包括病变的定位诊断、定性诊断及恶性梗阻的手术可切除性预测,并与手术病理、经内镜逆行性胰胆管造影术（ERCP）或经皮肝穿胆道造影术（PTC）结果对照。结果：MR平扫（包括MRCP）及冠状面LAVA技术对低位胆道梗阻的定位诊断准确率分别为86%（43/50）、88%（44/50）,两组间无统计学差异（P=1.000）;定性诊断准确率分别为78%（39/50）、92%（46/50）,两组间差异具有统计学意义（P=0.039）;MR平扫（包括MRCP）结合冠状面LAVA的手术可切除性预测准确率为90.3%（37/41）。结论：MR冠状面LAVA动态增强可以直观地显示病变的位置、特征及与周围组织的关系,在低位胆道梗阻的定性诊断中具有重要作用,MR平扫结合冠状面LAVA增强扫描对于低位恶性胆道梗阻术前可切除性预测准确率较高。     

3.0T MR平扫及LAVA技术在恶性低位胆道梗阻术前诊断中的价值

目的 评价3.0T MR平扫[包括磁共振胰胆管成像(MRCP)]及肝脏快速容积采集(LAVA)技术在恶性低位胆道梗阻术前诊断及评估中的价值.资料与方法 将52例经手术与病理证实为恶性低位胆道梗阻患者的MRI资料分为3组:(1)平扫(包括3D MRCP);(2)LAVA;(3)平扫+LAVA.在不知病理结果的情况下对3组资料进行判读与分析,包括病变的定位诊断、定性诊断及手术可切除性预测,并进行统计学检验.结果 MR平扫(3DMRCP)、LAVA、平扫+LAVA 3组对肿瘤的定位诊断准确率分别为96.2%、98.1%、100%;定性诊断准确率分别为71.2%、88.5%、94.2%,第一组与第二组、第三组间P值分别为0.028、0.002,差异有统计学意义,第二组与第三组间P=0.488,差异无统计学意义.3组资料手术可切除性预测的准确率分别为75.0%、90.4%、90.4%,第一组与第二、三组间差异有统计学意义(P=0.038).结论 3D MRCP可准确判断梗阻部位,对于病变的定位诊断具有较大的优势;LAVA技术由于可以提供更多病变的直接征象和强化特征,因此在肿瘤的定性诊断及可切除性评估中具有重要作用.     

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。     

MRCP联合LAVA序列增强在梗阻性黄疸中定性诊断的价值

目的:评价MRCP联合LAVA序列增强对梗阻性黄疽定性诊断的价值。方法:回顾性分析57例经手术及病理证实的梗阻性黄疸病人常规MR平扫、MRCP和LAVA序列增强的综合表现,并与手术结果进行对照分析。结果:梗阻性黄疸MRCP联合LAVA序列增强诊断与病理诊断的定性诊断符合率为93.0%;分类比较符合率为:恶性梗阻87.0%,结石性梗阻100%,良性梗阻83.3%。恶性梗阻组与良性梗阻组符合率的差异有统计学意义(P<0.05)。结论:MRCP联合LAVA序列增强对梗阻性黄疸定性诊断特异性较高,有利于对梗阻性黄疸性质的诊断。     

MRI特殊序列对梗阻性黄疸定性诊断的价值

目的 探讨MR胆胰管成像( MR cholangiopancreatography,MRCP)和容积式插入法屏气检查(volume imaging body exam,VIBE)序列在梗阻性黄疸中定性诊断的价值.方法 对119例梗阻性黄疸病人的MRCP结合MRI VIBE序列诊断与最终诊断[经皮穿刺胆道造影术(PTC)或内窥镜逆行性胰胆管造影术(ERCP)及手术、病理结果]进行回顾对照分析,评价MRI特殊序列对梗阻性黄疸定性诊断的价值.结果 梗阻性黄疸MRCP和VIBE诊断与最终诊断的定性诊断符合率为94.1%;分类比较符合率为:结石性梗阻100.0%,除结石外良性梗阻83.9%,恶性梗阻94.3%.恶性梗阻组与除外结石良性梗阻组符合率的差异有统计学意义.结论 MRI特殊序列对梗阻性黄疸定性诊断特异性较高.     

MRCP联合LAVA技术诊断低位胆道梗阻性病变的价值

目的探讨磁共振胰胆管造影（MRCP）及快速三维容积动态增强扫描（LAVA）联合应用在低位胆道梗阻中的诊断价值。方法回顾性分析50例经手术、病理证实及临床随访证实的低位胆道梗阻患者的MRCP及LAVA增强影像表现,包括病变部位、大小、范围及其周围受侵情况等。结果 MRCP与LAVA对低位胆道梗阻性病变的定性诊断准确率分别为90%和86%,两者比较无显著性差异（P〉0.05）,MRCP与LAVA两者联合诊断准确率为96%,与单项MRCP或LAVA检查的准确率比较无显著性差异（P〉0.05）。结论 MRCP结合LAVA联合应用能较好地对低位胆道梗阻性病变进行定位、定性诊断,提高早期肿瘤的检出率,并能准确描述病变的范围及其浸润或累及范围。     

肝门区胆管梗阻的MR诊断

目的 :探讨肝门区不同病变的MR表现特征 ,评价MR对肝门区病变的诊断价值。方法 :对 3 3例肝门区胆管阻塞的病人进行MR平扫和磁共振胰胆管成像 (MRCP) ,其中 2 4例行MR动态增强扫描和增强后血管成像。结果 :MR清晰显示了肝门区胆管阻塞情况和胆管内外的病变 ,3 3例病变中 ,肝门区胆管癌 17例 ,胆管炎性狭窄 4例 ,其它恶性肿瘤侵犯 8例 (包括原发性肝癌 3例 ,胆囊癌 3例 ,胰腺癌 2例 ) ,胆管结石 2例 ,腹腔镜胆囊切除术误扎肝总管 2例。结论 :MR平扫结合MRCP和动态增强 ,对肝门区胆管阻塞能作出准确的定位和定性诊断     

磁共振胰胆管成像对阻塞性黄疸的诊断价值

目的探讨磁共振胰胆管成像对阻塞性黄疸的诊断价值,为这种方法应用于临床诊断提供参考和依据。方法收集我院2011年1月—2012年3月收治的72例阻塞性黄疸患者的临床资料。术前常规给予MRCP联合MRI平扫加增强检查,然后将术前影像检查结果与术中所见结果的一致性进行比较分析。结果 (1)72例患者定位定性诊断分析,MRCP的定性诊断正确率为84.7%(61/72),其定位准确率为94.4%(68/72),MRCP联合MRI平扫+增强定性定位诊断正确率均为100%(72/72),与手术结果相一致。(2)良性梗阻以胰头上区及胰头区多见,二者占65.2%(40/48),恶性梗阻以十二指肠乳头区最多占63.4%(17/24)。(3)胆道梗阻扩张程度,良性扩张以轻度为主,恶性扩张以重度为主,两组进行比较,差异有统计学意义(P<0.01)。(4)对比胆管结石患者,MRCP测量结石大小与手术比较差异无统计学意义(P>0.05);MRCP测量肿瘤大小与手术进行比较,无统计学意义(P>0.05)。(5)恶性梗阻性黄疸分为胆管癌、壶腹部癌、胰头癌三组,术前根据MRCP判定根治率分别是25%、80%和50%。术中判定的根治率分别为37.5%、100%和66.67%。(6)24例阻塞性黄疸的术前MRCP评估和术中评估进行配对χ2检验,差异无统计学意义(P>0.05)。结论 MRCP对阻塞性黄疸定位准确率可达100%,磁共振胰胆管成像具有准确、无创、直观显示胰胆管的形态学特点,联合MRI平扫及增强检查,能够为外科手术提供更加准确可靠的依据。     

MRCP联合LAVA技术对肝门部胆管癌的诊断价值

目的 探讨磁共振胰胆管造影（MRCP）及动态增强扫描（LAVA）联合应用在肝门部胆管癌的诊断价值.方法 回顾性分析43例经手术、病理证实的肝门部胆管癌的患者进行常规MR平扫、LAVA动态增强和MRCP表现,明确肿瘤的部位、大小、分型、邻近受侵情况.结果 43例肝门部胆管癌患者中,结节型15例,腔内乳头状型6例,浸润型22例.MRCP显示扩张的肝内外胆管及梗阻部位的狭窄、中断、截断和管腔内的充盈缺损.MR平扫及LAVA增强扫描主要表现为肝门部软组织肿块或胆管壁不规则增厚及其渐进性强化,同时可以显示出癌灶与邻近血管和脏器的毗邻关系及受累情况.结论 MRCP和LAVA联合应用对肝门部胆管癌的诊断及形态学分型具有明显的优势,其影像学结果对临床治疗有较大指导意义.     

MRCP、FIESTA序列和LAVA序列动态增强扫描诊断肝外胆道梗阻的对比研究

目的:评价FSE序列MRCP、FIESTA序列和LAVA动态增强扫描诊断肝外胆道梗阻的临床价值。方法:对50例经超声诊断肝外胆道梗阻的患者,以1.5T HD MR行FSE序列MRCP、FIESTA序列冠状位扫描,并以LAVA序列行冠状动态增强扫描,分别在注射Gd-DTPA后10、30和60s行3期冠状位扫描,将FIESTA序列图像及LAVA序列动态增强图像、MRCP诊断结果与手术病理进行对比。结果:MRCP可以显示梗阻的部位以及可能的病因,但对病变的侵犯范围显示能力有限;FIESTA序列可以显示梗阻的部位、胆管与门静脉的关系,显示胆管结石有较大的价值,但对胆管的肿瘤、胰头部肿瘤显示能力不足;LAVA序列动态增强扫描对恶性肿瘤所致的梗阻有较强的诊断能力,尤其是在诊断肿瘤的侵犯范围方面有较大的临床意义。结论:肝外胆道梗阻的MRI检查可先行FIESTA序列扫描及MRCP扫描,对疑诊断肿瘤的患者可行LAVA序列动态增强扫描。     

MR cholangiopancreatography: value of axial and coronal fast Spin-Echo fat-suppressed T2-weighted sequences

OBJECTIVE: To compare axial and coronal fast Spin-Echo fat-suppressed T2-weighted sequences with three-dimensional (3D) maximum intensity projection (MIP) images in patients with suspected pancreaticobiliary obstruction. MATERIAL AND METHODS: MR cholangiopancreatography (MRCP) was performed in 108 consecutive patients with a non-breath-hold, fat-suppressed, 2D, heavily T2-weighted fast spin-echo sequence in coronal plane. Axial T1- and T2-weighted images were previously obtained. In addition, 3D reconstructions of the coronal images were analysed separately by using a MIP algorithm. Both two-dimensional (2D) (axial and coronal) and 3D MIP images were separately evaluated by two readers in conference and their results were compared with that of endoscopic retrograde cholangiopancreatography, percutaneous trans-hepatic cholangiography, surgery and/or imaging follow-up. Statistical analysis of 2D and 3D MRCP images in diagnosing the level and probable cause of pancreaticobiliary obstruction were separately calculated. RESULTS: 106/108 of MRCP examinations were judged diagnostic by the two reviewers for adequacy of visualisation of the biliary and pancreatic ducts. Sensitivity, specificity, positive predictive value, negative predictive value and global diagnostic accuracy of 2D (axial and coronal) and 3D MRCP images in diagnosing the pancreaticobiliary obstruction were 94 and 57%,, 95 and 93%, 97 and 92%, 91 and 60%, 94 and 72% respectively. CONCLUSION: Our results do indicate a higher global accuracy for axial and coronal fast Spin-Echo fat-suppressed T2-weighted sequences versus 3D MIP images in diagnosis of the level and probable cause of pancreaticobiliary obstruction and stress the limitations of 3D images in depiction of small intraductal pathology such as calculi and biliary neoplastic.     

Using kinematic MR cholangiopancreatography to evaluate biliary dilatation

OBJECTIVE: The purpose of this study was to evaluate the usefulness of kinematic MR cholangiopancreatographic (MRCP) images as an aid in predicting the need for intervention in patients with biliary dilatation. SUBJECTS AND METHODS: Fifty patients with suspected pancreaticobiliary disorders were separated into three groups. Group I patients had biliary dilatation with periampullary lesions (n = 16), group II patients had supraampullary obstructive lesions (n = 17), and group III patients had biliary dilatation without obstruction (n = 17). Twenty consecutive single thick-slice MRCP images were obtained in the 15 degrees or 30 degrees left anterior oblique coronal plane. Two radiologists jointly reviewed the images without knowledge of the final diagnosis. The numbers of images showing relaxation of the sphincteric segment and the configuration of the distal margin of the common bile duct for the three groups were compared. RESULTS: Relaxation of the sphincteric segment was observed on the images of only two patients (12%) in group I but on the images of all patients in groups II and III, although not on all images. Lack of visualization of sphincteric relaxation on the kinematic MRCP images had a sensitivity of 88% and a specificity of 100% for the diagnosis of periampullary lesions. Most patients whose images did not show sphincteric relaxation required biliary intervention at the sphincter level. CONCLUSION: Nonvisualization of sphincteric relaxation on kinematic MRCP indicates ampullary or periampullary lesions. Kinematic MRCP can be used to determine the necessity of biliary intervention in patients with biliary dilatation.     

磁共振胰胆管成像在诊断胰胆管疾病中的价值

目的：评价磁共振胰胆管成像(MRCP)诊断阻塞性和扩张性胰胆管疾病的临床价值。方法：采用西门子symPhonyl．5T超导磁共振成像仪，对72例胰胆管系统疾病患和20例正常对照组进行MRI和MRCP成像，其中病变组22例进行Gd-DTPA动态增强。分析图像，将诊断结果与手术病理和超声、CT等其它影像检查结果对照。结果：MRCP能清晰显示正常胰胆管树的结构，能直观显示胰胆管扩张和梗阻的部位、形态、范围。检出率和定位率为94、3％，定性率为85．7％。MRI图像能帮助定性诊断。结论：MRCP是一种安全、有效的胰胆管系统影像检查方法，与MRI结合，对诊断和鉴别诊断胰胆管阻塞性和扩张性疾病有较高的临床诊断价值，     

Imaging of the intrahepatic biliary tree with thick slice MR cholangiography]

PURPOSE: To assess the value of single shot fast spin echo MR sequence (SS-FSE) in the evaluation of the normal and pathologic intrahepatic biliary tree. MATERIAL AND METHODS: 418 consecutive patients (457 examinations) referred for clinical and/or biological suspicion of biliary obstruction underwent MR cholangiopancreatography (MRCP). All patients were imaged with a Signa 1.5 T GE MR unit, with High Gradient Field Strength and Torso Phased Array Coil. Biliary ducts were imaged with SS-FSE sequence, coronal and oblique coronal 20 mm thick slices on a 256 x 256 matrix. Total acquisition time was 1 second. Source images were reviewed by two radiologists blinded to clinical information. In case of disagreement, a third radiologist's opinion was requested. In all cases, MRCP results were compared with direct biliary tract evaluation, other imaging studies and clinical and biological follow-up. RESULTS: In all cases, MRCP produced high quality images. Numerous branch of division were observed although the peripheral intrahepatic ducts were well seen in more than 90% in an area 2 cm below the capsule. The number of division was statistically higher when mechanical obstruction was present. Intrahepatic calculi or peripheral cholangiocarcinoma were well detect by MRCP. For the detection of cholangitis, MRCP sensitivity was 87.5% but the positive predictive value was only 57.7% because of a high number of false positive. The diagnosis of primary sclerosing cholangitis must be made only on strict criteria and slightly dilated peripheral bile ducts unconnected to the central ducts in several hepatic segments were a characteristic MR sign of primary sclerosing cholangitis. CONCLUSION: MRCP can be proposed as a first intention imaging technique for the evaluation of intrahepatic ducts.     

磁共振胰胆管造影临床应用的价值评价

目的：探讨磁共振胰胆管造影（MRCP）在胆胰疾病中的应用价值。方法：采用重T2加权MR水成像技术对73例患者行MRCP检查。图像经三维最大信号强度投影（3D-MIP）及三维表面遮蔽显示技术（3D-SSD）后处理。结果：73例患者,4例为正常胰胆管,69例胆胰疾病中,梗阻性黄疸者58例,其中恶性胆道梗阻43例,良性胆道梗阻15例,非梗阻性病变11例,在梗阻性黄疸病例中,MRCP定位准确率为100%,并清楚显示扩张胆管程度及断端形态,对于恶性胆阻性病变11例,在梗阻性黄疸病例中,MRCP定位准确率为100%,并清楚显示扩张胆管程度及断端形态。对于恶性胆道梗阻。结合常规MRI可明显提高定性准确率83.7%,同时可显示肿块大小、范围及周围脏器侵犯情况。良性梗阻MR-CP检查的定性准确率为92.9%。在非梗阻性病例中,MRCP可清楚描绘胆囊结石、胆系术后改变及含液丰富的病变（胰腺假性囊肿、总胆管囊肿、十二指肠憩室等）与胰胆管之间的毗邻关系。结论：MRCP可准确揭示胆管梗阻部位,明确病变性质,MRCP对于非梗阻性胆胰疾病则有助于了解病变与周围脏器的毗邻关系。但MRCP作为一种影像检查技术。不能脱离常规CT、MRI,而是对常规影像检查的一种有效补充。     

肝外胆管梗阻的磁共振胆胰管造影诊断

目的 评价磁共振胆胰管造影（ＭＲＣＰ）对肝外胆管梗阻性疾病的临床诊断价值。方法 对５４例肝外胆管梗阻性疾病（肝外胆管结石３０例,恶性胆管梗阻２４例）进行ＭＲＣＰ检查,并与临床诊断或手术和病理结果对照分析。ＭＲＣＰ采用不屏气快速自旋回波（ＴＳＥ）序列重工Ｔ２ＷＩ扫描,结合呼吸触发及脂护抑制技术,原始图像以最大信号强度投影（ＭＩＰ）法进行三维重建。结果 全部５４例ＭＲＣＰ检查均一次成功,５２例胆胰管显     

Pancreaticobiliary diseases. Comparison of 2D single-shot turbo spin-echo MR cholangiopancreatography with endoscopic retrograde cholangiopancreatography

PURPOSE: To compare the diagnostic value of MR cholangiopancreatography (MRCP) to that of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of various obstructive and nonobstructive pancreaticobiliary diseases. MATERIAL AND METHODS: We retrospectively reviewed 153 patients who had undergone both MRCP and ERCP Breath-hold, heavily T2-weighted images using 2D single-shot turbo spin-echo technique were obtained. MRCP and ERCP results were correlated with the final clinical diagnoses. Accuracy of MRCP and ERCP in the diagnosis of pancreaticobiliary diseases, detecting the cause and site of biliary obstruction, if present, and distinguishing malignant from benign cause of obstruction were compared. RESULTS: Success rates of MRCP and ERCP were 98.7% and 89.5%, respectively. The accuracy of MRCP and ERCP in detecting the site of biliary obstruction was 89.7% and 96.2%, and in detecting the cause of biliary obstruction 69.2% and 71.8%, respectively. The sensitivity, specificity and likelihood ratios for positive and negative tests for MRCP and ERCP in distinguishing malignant biliary obstruction from benign causes were 86.4%, 82.4%, 4.9, 0.2 and 88.6%, 94.1%, 15.1, 0.1, respectively. Concordance between the two tests was 91% (kappa coefficient 0.82, standard error of kappa 0.113, p<0.001). In the group of nonobstructive biliary diseases, accuracy of MRCP and ERCP in detecting cholecystolithiasis were 100% and 73.7%, and in detecting pancreatitis 57% and 14%, respectively. CONCLUSION: 2D single-shot turbo spin-echo MRCP can be performed as a complement to ERCP and can replace ERCP in high-risk patients and in case of unsuccessful cannulation.