口服枸橼酸铁铵前后MRCP的临床应用

目的探讨口服枸橼酸铁铵前、后MRCP的临床应用价值.方法对86例怀疑胆胰系病变者行口服枸橼酸铁铵前、后MRCP及常规MRI,对服用对比剂前后MRCP图像质量、服药前MRCP与综合服药前、后MRCP诊断准确率进行自身对照研究.结果服用对比剂后MRCP图像质量明显提高(P<0.001);结合常规MRI,综合服药前、后MRCP对胆胰系病变的定位、定性诊断准确率均较服药前MRCP高(P<0.05). 结论口服枸橼酸铁铵能明显提高MRCP的成像质量;综合服药前、后MRCP对诊断胆胰系病变具有重要的临床应用价值.     

口服枸橼酸铁铵在3.0T高场强MR上腹部检查中的初步研究

目的通过使用3.0T磁共振扫描仪对口服枸橼酸铁铵前后进行上腹部成像,研究该对比剂在高场强磁共振上腹部检查中的临床应用价值。方法对9例健康志愿者在服用浓度为7.55mmol/L的枸橼酸铁铵前后使用相同的扫描参数进行横轴位常规T1WI、T2WI成像和磁共振胰胆管成像(MRCP),按不同解剖部位显示情况分别进行评分并进行统计学分析。结果口服对比剂后胃、十二指肠降部及肝左叶边缘的显示在不同序列的横轴位图像上都有显著改善,MRCP对胰胆管的显示也有显著改善,配对秩和检验的结果P<0.05。结论在上腹部高场强磁共振检查中使用枸橼酸铁铵对比剂可以明显改善胃肠道内液体对MRCP图像的影响,对横轴位图像的显示也有明显的改善作用。     

口服复锐明在低场磁共振诊断肝外胆管梗阻病变中的应用及评价

目的探讨口服复锐明在低场磁共振诊断肝外胆管梗阻病变中的诊断价值。方法40例受检患者随机归入本次研究，在口服复锐明（枸橼酸铁铵）前后分别行磁共振胰胆管成像（MRCP）检查。结果口服复锐明后，MRCP图像级别显著提高，达到诊断要求的图像由用药前的7．5％升至用药后的85．0％。用药前后图像级别变化差异有非常显著性（P〈0．01）。结论口服复锐明对低场磁共振诊断肝外胆管梗阻病变具有重要价值，对MRCP图像质量改善具有一定意义。     

葡萄糖酸亚铁溶液在磁共振胰胆管成像中的应用

目的评价口服葡萄糖酸亚铁糖浆溶液在磁共振胰胆管成像(MRCP)中的应用价值。方法实验部分:将不同浓度医用硫酸钡和葡萄糖酸亚铁糖浆两种溶液装入不同试管中,行MRT2WI和singleshot扫描,改变TE时间,观察信号强度和不同反转时间(TI)信噪比的变化。临床试验:把100位患者随机分成两组行不服对比剂和口服钡或铁剂5、10、15min分别进行检查,观测胃肠道图像信噪比变化及以胰胆管解剖结构为对象的MRCP图像的改善情况。结果60%硫酸钡和14%葡萄糖酸亚铁溶液将水信号基本抑制;当TI时间为130ms左右时,铁剂溶液的信噪比强度降低明显;钡剂和铁剂的信号随TE时间的延长而降低。服用钡剂和铁剂后胃内信噪比平均值降至1.043±0.456,P<0.001;服用对比剂后十二指肠的平均信噪比降至1.930±2.315,1.933±2.320,P<0.001。口服对比剂前与口服对比剂后10minMRCP成像比较,对胆总管、胰管、胆囊结构的显示,钡剂和铁剂均具有显著性差异(P=0.012,0.010,0.014;P=0.013,0.011,0.015);与口服对比剂后15min成像比较,对胆总管、胰管、胆囊结构的显示,钡剂和铁剂均具有显著性差异(P=0.006,0.018,0.024;P=0.007,0.019,0.025),但后者图像更佳。结论口服阴性胃肠道对比剂(V/V)14%葡萄糖酸亚铁糖浆溶液约500ml后,15min进行MPCP检查,将获得极佳的MRCP图像。葡萄糖酸亚铁溶液是MRCP成像时良好的胃肠液抑制剂,使MRCP图像更加清楚,使对胰胆系疾病的定位、定性及定量诊断更加准确。     

使用枸橼酸铁铵抑制3D-MRCP图像中胃肠信号的初步研究

目的　评价使用枸橼酸铁铵后 3D MRCP图像的改善程度。方法　本组共收集MRCP病人 3 0例。在服用枸橼酸铁铵前、后以相同的采集参数对其行 3D MRCP成像。图像评价从胃肠信号消除情况和图像质量改善情况两方面进行。结果　使用造影剂后胃部的对比信噪比由 7.0 64± 3 .85 3降至 1.0 41± 0 .45 9,十二指肠则由 5 .494± 3 .916降至 1.93 1± 2 .3 17,两者的P值均小于 0 .0 0 1;MRCP的图像质量由造影前的 2 .83 3± 2 .0 5 2增至 9.13 3± 2 .0 3 0 ,P <0 .0 0 1。结论　使用枸橼酸铁铵几乎可完全消除 3D MRCP图像中的胃肠信号 ,明显改善图像质量。     

口服静脉用钆喷酸葡胺改善MRCP图像质量研究

目的:选择出静脉用钆喷酸葡胺(Gd-DTPA)作为MRCP口服胃肠道阴性对比剂的最佳浓度及容量;评价口服Gd-DTPA对比剂在抑制胃肠道高信号、改善MRCP图像质量中的作用。方法:体外实验,对不同浓度Gd-DTPA稀释液及温开水空白对照组行T1WI、T2WI、单层TSE序列及HASTE序列扫描,测量不同成像序列上的信号强度并计算增强率,选择出最佳浓度。临床实验,分别配制不同容量的最佳浓度Gd-DTPA稀释液作为MRCP口服胃肠道阴性对比剂,选择出最佳容量;以最佳浓度和容量Gd-DTPA对比剂对24例临床疑有胰胆管病变的患者行口服前及口服后5～10min、10～15minMRCP扫描,分析图像质量。结果:T1WI上对照组均为低信号,Gd-DTPA浓度≤0.01mol/L时为完全高信号;T2WI上对照组为明亮高信号,Gd-DTPA浓度≥0.015mol/L为完全低信号;2DTSE单层MRCP图像上对照组为明亮高信号,Gd-DTPA浓度在0.0025～0.03mol/L之间均为低信号;3DHASTEMRCP图像上对照组为明亮高信号,Gd-DTPA浓度≥0.01mol/L时为完全低信号;容量≥100mL浓度为0.01mol/L的Gd-DTPA对比剂对胃及十二指肠内液体高信号的抑制效果完全;24例患者口服100mL浓度为0.01mol/L的Gd-DTPA对比剂5～10min、10～15min后MRCP图像上胰胆管树各解剖结构的平均等级分数差异无显著性(P>0.05),而口服对比剂后肝内三级胆管、胆总管、胰管的平均等级分数高于口服对比剂前并差异有显著性(P<0.05)。结论:100mL浓度0.01mol/L的Gd-DTPA对比剂能使胃及十二指肠内潴留液高信号抑制完全,可作为MRCP理想的胃肠道阴性对比剂;口服该对比剂后5～10min行MRCP扫描,图像质量效果最佳。     

口服联合静脉注射钆喷酸葡胺改善磁共振胰胆管成像图像质量及临床应用

目的：评价口服联合静脉注射钆喷酸葡胺（Gd—DTPA）增强在抑制胃肠道高信号及腹部小血管高信号中的作用,改善磁共振胰胆管成像（MRCP）图像质量以提高对胰胆管病变的诊断及鉴别诊断水平。方法：在体外及临床实验的基础上．选取2mL静脉用Gd—DTPA配制成100mL浓度为0．01mol／L的稀释液作为最佳浓度和容量的MRCP口服用胃肠道阴性对比剂。对21例疑有胰胆管病变的患者行联合口服及静脉注射Gd—DTPA增强后10min行MRCP检查．分析增强前后胰胆管及病变的显示情况。结果：21例患者口服联合Gd-DTPA增强MRCP图像上,来自胰胆管树背景上的小血管信号影以及胃、十二指肠内潴留液高信号被明显抑制．肝脏和胰腺实质信号强度显著降低,使得胰胆管树各解剖结构的对比度提高,显示更加清楚,图像质量较口服联合Gd—DTPA增强前明显改善。结论：对于明确或高度怀疑有胰胆管病变的患者,口服联合静脉注射Gd—DTPA增强能抑制胃、十二指肠内潴留液的高信号以及胰胆管树背景上的小血管信号,能进一步改善MRCP图像质量,结合动态增强T1WI能为胰胆管病变的诊断及鉴别诊断提供更多帮助。     

几种常见饮料作口服阴性对比剂在MRCP检查中的可行性分析

目的探讨几种常见饮料在磁共振胰胆道成像(MRCP)中降低胃肠道液体干扰的可行性。方法 (1)体外试验:将10种不同品牌的饮料及4种不同浓度(4、6、8、10g/150mL)的绿茶分别盛入14支20mL注射器内,以纯净水作为参照物,然后行MRCP扫描,筛选出对降低胃肠道液体干扰最明显的饮料用于临床试验。(2)临床试验:对12例健康志愿者于口服绿茶前、口服绿茶后10min行MRCP扫描,观察并比较胃、十二指肠信号丢失情况及胆道系统图像质量。结果 (1)体外试验显示几种常见饮料中,4种不同浸泡浓度的绿茶对降低胃肠道液体干扰最明显,考虑到口感因素,故选择4g/150mL的绿茶用于临床试验。(2)12例健康志愿者口服绿茶后10min胃、十二指肠信号丢失,胆总管、胆胰壶腹、胰管及胆囊的图像质量均优于口服绿茶前(P0.05)。结论绿茶作为一种安全、廉价、易获取、口感好的饮料,能够降低胃肠道液体对MRCP图像质量的影响,可应用于临床。     

枸橼酸莫沙必利分散片对功能性消化不良患者近端胃舒张和排空功能的影响

目的 探讨枸橼酸莫沙必利分散片对功能性消化不良(FD)患者近端胃舒张和排空功能的影响.方法 选择我院2012年1-12月住院的FD患者60例为FD组,给予枸橼酸莫沙必利分散片5 mg/次、3次/d口服;另选择我院同期健康体检者60名为对照组,应用超声GE-200型诊断仪检测对照组入选时和FD组患者服药前后胃底气体评分、延迟排空相、近端胃容积、近端胃液体半排空时间(T1/2).结果 FD组延迟排空相服药前为(5.98±3.52) min,服药后为(4.83±2.52) min,差异有统计学意义(t =2.91,P＜0.01);FD组服药前胃液体T1/2为(18.98±8.52) min,服药后为(24.83±7.52) min,对照组为(26.11±4.51) min,胃液体T1/2FD组服药1前低于对照组,服药后高于服药前,差异均有统计学意义(t值分别为6.07、5.63,P均＜0.05).结论 枸橼酸莫沙必利分散片可改善FD患者的近端胃舒张功能,加快胃排空速度.     

静脉注射钆喷酸葡胺增强改善MRCP图像质量研究

目的：评价静脉注射钆喷酸葡胺（Gd-DTPA）增强在改善磁共振胰胆管成像（MRCP）图像质量的作用。方法：选择临床疑有胰胆管病变并准备行MRI检查患者31例作为研究对象，所有患者分别行Gd-DTPA增强前及增强后1．5min、5-10min、10．15min MRCP扫描。测量并比较增强前后MRCP图像上肝脏、胰腺、胆总管、胰管的信噪比（SNR）以及胆总管与肝实质、胰管与胰腺的信号强度比（SIR）。结果：静脉注射Gd-DTPA增强后1-5min、5．10min及10．15min图像上胰胆管树各解割结构显示情况和平均等级分数均无统计学差异（P〉0．05）；Gd-DTPA增强后的MRCP图像胰胆管树解剖结构显示情况和平均等级分数与增强前比较差异有显著性（P〈0．001）。Gd-DTPA增强后MRCP图像上来自肠系膜上静脉及其分支与胰管重叠的血管信号、左右门静脉及其分支与肝内二级胆管重叠的血管信号被明显抑制。肝脏及胰腺信号强度降低，胰胆管树对比度提高，肝内2级胆管、肝总管、胆总管和胰管显示更加清楚。结论：MRCP成像中，静脉注射Gd-DTPA增强能抑制来自左右门静脉和肠系膜上静脉及其分支等血管的高信号，提高胰胆管树的对比度，明显改善MRCP图像质量。[著者文摘]     

Use of pineapple juice with gadopentetate dimeglumine as a negative oral contrast for magnetic resonance cholangiopancreatography: a multicentric study

We evaluated the efficacy of pineapple juice with gadopentetate dimeglumine as a negative oral contrast agent for magnetic resonance cholangiopancreatography (MRCP). Images were obtained before and after the intake of a negative oral contrast agent. Images obtained from six different areas of the biliary tree were analyzed by three different radiologists, who were blind to the exams; scores regarding image quality were given to each area. The statistical analysis showed a significant difference between images before and after the use of the contrast agent (P < 0.001) for the three radiologists (R1–R3). Mean scores given by radiologists before the intake of the contrast agent were 2.49 ± 0.42 (R1), 2.62 ± 0.32 (R2), and 2.22 ± 0.46 (R3). After the intake, mean scores were 3.38 ± 0.62 (R1), 3.48 ± 0.55 (R2), and 2.89 ± 0.69 (R3). The ducts that showed the highest scores were the common bile duct and duct of Wirsung, the distal portion of the common bile duct and the cystic duct. We suggest herein that the contrast agent pineapple juice with gadopentate dimeglumine constitutes an efficient negative oral contrast agent for MRCP, for it efficiently eliminates the signal of the digestive tube in MRCP images.     

Gadopentetate dimeglumine as an oral negative gastrointestinal contrast agent for MRCP

Background: We investigated the feasibility of using intravenous magnetic resonance (MR) contrast agent as a gastrointestinal oral negative contrast agent to null the bowel signal during MR cholangiopancreatography (MRCP). Methods: In the first part of the study, a phantom study was performed to select the optimal concentration of MR contrast agent to be used as an oral negative contrast agent in MRCP. In the second part of the study, 23 consecutive patients suffering from different pancreaticobiliary diseases were imaged with a single-shot fast spin-echo pulse sequence. The data acquisition was started without oral contrast agent and then repeated with oral contrast agent. From the MR images taken with and without oral contrast agent, the gallbladder, cystic duct, common bile duct, and pancreatic duct were assessed and graded by two radiologists. Results: The oral contrast agent was tolerated well by all patients. In all patients the high signal intensity from the intestinal fluid was completely suppressed. The depictions of the gallbladder and cystic duct were slightly and moderately improved, respectively, whereas the depictions of the common bile duct and pancreatic duct were markedly improved by the oral contrast agent administration. Conclusion: Diluted intravenous MR contrast agent can be an effective and safe oral negative contrast agent in eliminating signal intensity of the gastrointestinal tract, thus improving the depiction of the biliary system in MRCP. Received: 14 September 1999/Revision accepted: 12 January 2000     

使用枸橼酸铁铵抑制3D-MRU图像中胃肠信号的初步研究

目的：评价使用枸橼酸铁铵后3D-MRU图像改善的情况。材料与方法：我们以相同的采集参数对共计22例病人在服用枸橼酸铁铵前、后分别行3D-MRU成像。图像评价从胃肠信号消除情况和图像改善情况两方面进行。结果：使用造影剂后左、右肾门周围的小肠信号则分别由1.10±1.22和1.28±0.96降至0.62±0.39和0.57±0.32。使用造影剂后,左、右肾门周围小肠信号均有显著性降低（两者的P值均小于0.05）;而左、右两区间的小肠信号降低程度无显著性差异（P>0.05）。MRU的图像质量在造影前后则分别为4.25±1.84,7.75±1.84（P<0.05）。结论：枸橼酸铁铵的使用几乎可完全消除3D-MRU图像中的胃肠信号,明显改善图像质量。     

Fentanyl-augmented MRCP

Background Drugs such as secretin and morphine have been used to augment the visualization of magnetic resonance cholangiopancreatography (MRCP). This study investigated the effectiveness of intravenous administration of a synthetic opioid, fentanyl, in improving the MRCP image quality. Methods Thirty consecutive patients with a provisional diagnosis of benign biliary and/or pancreatic disease underwent MRCP. Coronal single-shot fast spin-echo heavily T2-weighted dynamic MRCP images were generated before and at every minute for 10 min after intravenous administration of fentanyl citrate at a dose of 1.0 μg/kg. Pre- and postinjection images were compared and analyzed qualitatively and quantitatively. Results Qualitatively, visualization of intrahepatic bile ducts, common bile duct, and main pancreatic duct improved after fentanyl injection in five (16%), 11 (37%), and 19 (63%) patients, respectively. The pancreatobiliary junction and common channel were visualized better after fentanyl injection in eight of the 18 patients (44%). Quantitatively, signal intensity and diameters of the intrahepatic ducts, common bile duct, and main pancreatic duct measured at corresponding points on pre- and postinjection images showed an increase above preinjection values in 28 (93%), 27 (90%), and 21 (70%) and in 18 (60%), 26 (86%), and 22 (73%), respectively, and these changes were highly significant at all sites (p < 0.001). Conclusions Intravenous administration of fentanyl before MRCP improves qualitative and quantitative visualization of the ductal system anatomy that may be of value in clinical diagnosis and management.     

Influence of paramagnetic contrast on single-shot MRCP image quality

To assess the ability of gadolinium enhancement to suppress the overlapping vessel signals that diminish the image quality of magnetic resonance cholangiopancreatography (MRCP), we obtained MRCP before and after intravenous injection of gadolinium. Signal intensity ratio of the common bile duct to the main pancreatic duct was significantly improved after the injection of contrast media. The image quality of the postcontrast MRCP was better than that of the precontrast one.