MRCP与True FISP序列在梗阻性黄疸诊断中的比较

目的比较MRCP与True FISP序列在诊断梗阻性黄疸中的价值.方法对临床怀疑有梗阻性黄疸的30例病人的MRCP与True FISP序列分别进行阅片诊断,再结合其他序列进行诊断;最后与病理结果进行对比分析.结果 MRCP与True FISP序列判断有无梗阻及梗阻部位的敏感性和特异性均很高, 但True FISP序列的正确定性率(61.9%)高于MRCP(54.5%).而结合T1WI、T2WI序列后正确定性率达86.7%.结论 MRCP与True FISP序列均能很好的判断有无胆管梗阻及梗阻部位,MRCP对胰胆管整体显示较好,不易漏诊小病变.但在定性方面,True FISP序列优于MRCP.单凭MRCP 或True FISP 不能区别炎症和肿瘤.     

单次激发与多次激发MRCP诊断胆系结石的对照研究

目的：对比探讨单次激发快速自旋回波序列（SSFSE）与多次激发FSE序列（FSE）磁共振胰胆管成像（MRCP）诊断胆系结石的价值。方法：应用1.0T超导MRI扫描仪对128例患者（68例胆囊结石和60例胆总管结石）行二维冠状面SSFSE序列和FSE序列MRCP扫描。结果：对于较大的单发或多发胆囊结石以及胆囊泥沙样结石的显示，SSFSE序列图像优于FSE序列MIP图像。对于＜0．5cm的较小的单发或多发胆囊结石，SSFSE序列图像及FSE序列MIP图像均难以准确显示。对于胆总管结石，SSFSE序列和FSE序列MIP图像均可较好地显示。结论：SSFSE序列图像对于较大的单发或多发胆囊结石以及胆囊泥沙样结石的显示优于FSE序列MIP图像；但对于较小的单发或多发胆囊结石以及胆总管结石，SSFSE序列和FSE序列MIP图像的诊断价值相仿。     

MRIMRI多序列检查对胆系泥沙样结石的诊断价值

目的探讨MRI多序列检查对胆系泥沙样结石的诊断价值。方法收集2011年2月-2013年3月56例经手术或经内镜逆行性胰胆管造影术证实的胆系泥沙样结石患者的MRI资料,采用横断位T1加权像、横断位T2加权像加脂肪抑制、真稳态进动快速成像序列、磁共振胰胆管成像以及4种序列联合进行结石检出率比较。并选取157例非胆系泥沙样结石患者为对照组进行诊断试验。结果 4种序列联合运用,对泥沙样结石检出率最高,且与其每一单个序列比较,差异有统计学意义(P<0.005)。MRI多序列检查诊断胆系泥沙样结石的灵敏度为85.7%,特异度为84.1%,准确性为84.5%。胆系积脓为最常见的假阳性表现。结论采用MRI多序列检查,可提高胆系泥沙样结石检出率,但其诊断的特异性尚有待进一步研究。     

MR True FISP序列在评价肝癌侵犯门脉诊断中的应用研究

目的：探讨磁共振真实稳态进动快速成像（MR True FISP序列）用于诊断肝癌侵犯门脉的准确性,建立无创影像学检查技术对肝癌侵犯门脉的评价体系,指导手术治疗。材料及方法：收集临床已确诊为肝癌,并高度怀疑门脉受侵的患者90例,并有完整的MRI检查资料,所有患者均明确手术或穿刺病理证实。将所有MRI图像进行汇总分析,最后将True FISP序列检查结果与增强门脉期检查结果及手术或穿刺病理结果对比并进行对比分析。结果：建立MR True FISP序列的最佳成像参数和扫描方法。True FISP图像与增强门脉期冠状位图像大部分为优,二者的可诊断率均为100%。与病理对照分析,True FISP序列对肝癌侵犯门脉的显示有高度的一致性。结论：规范MR True FISP序列显示门脉的最佳成像参数和扫描方法;MR True FISP序列可以很好的显示肝癌病灶对门脉的侵犯情况,对诊断肝癌侵犯门脉的准确性很高,建立无创影像学检查技术对肝癌侵犯门脉的评价体系,从而指导外科手术治疗。     

疑似胆总管结石85例MRCP结果分析

目的:研究LC术前MRCP对胆囊结石合并隐匿性胆总管结石的诊断价值。方法:总结我院近2 a对85例胆囊结石疑胆总管结石的患者行MRCP检查结果,以手术探查结果作为金标准,并统计有无合并胰腺炎,B超示胆囊结石伴胆管扩张及肝功能异常等胆总管结石危险因素。结果:MRCP可明显提高胆总管结石的检出率。结论:MRCP可提高胆总管结石的检出率,有效降低LC术后胆总管残余结石的发生率。     

2D-MR胰胆管造影和平衡梯度回波序列对老年患者胆道结石诊断的联合应用

目的评估2D-MR胰胆管造影（MRCP）和平衡梯度回波（BFFE）序列联合应用对老年胆总管结石的诊断价值。材料与方法搜集2010年1月至2011年12月间进行MRCP检查≥70岁的114例怀疑胆总管结石的患者资料。由2名医师观察2D-MRCP图像,结合BFFE、T2WI评价是否存在胆总管结石。结果所有病例中MRCP能清晰显示胆道系统,114例患者中MR图像提示108例患者合并胆总管结石,6例患者无胆总管结石;手术及ERCP结果显示99例患者合并胆总管结石,15例患者无胆总管结石;对两组结果进行卡方检验差异有统计学意义（χ2=4.281,P=0.031）。结论 2D-MRCP结合BFFE序列能准确获得老年患者胆总管是否存在结石的情况,具有快速、安全的特点,特别适合不合作的患者。     

MRCP与True FISP序列在梗阻性黄疸诊断中的比较

本文旨在探讨磁共振胰胆管成像（MRCP）与真稳态进动快速成像（True FISP）对梗阻性黄疸的诊断价值。     

磁共振MRCP在诊断胆总管结石中的价值

目的:分析总结MRCP诊断胆总管结石的重要性。方法:通过30例经过手术确诊的胆总管结石病例,进行分析比较。结果:29例MRCP术前诊断胆总管结石,术后予以确诊,1例可疑结石,诊断准确率96.6%,B超术诊断结石16例,检出率53.3%,明显低于MRCP。结论:MRCP辅以常规MR扫描诊断胆总管结石准确率高,是安全、有效的检查方法,得到临床的广泛应用。     

胆总管疾病的MRI检查序列优化的研究

目的：探讨MRI多种技术对胆总管疾病诊断的最佳序列选择。材料与方法：收集经手术证实及临床随访、综合影像证实的胆总管疾病104例,行包括轴位T1WI、T2WI、DWI,冠状位FIESTA,MRCP及LAVA增强扫描的MRI检查。结果：2D、3D-MRCP结合FIESTA序列对胆总管结石定性诊断准确率100.0%,显著优于T1WI/T2WI（P<0.01);DWI结合LAVA增强扫描对胆总管恶性肿瘤的定性诊断准确率100.0%,显著优于T1WI/T2WI、2D、3D-MRCT结合FIESTA序列（P<0.01）。结论：对胆总管结石优化序列（FIESTA+MRCP）及胆总管恶性肿瘤优化序列（DWI+LAVA）定性诊断准确率均高于其它扫描序列。     

磁共振胰胆管成像在梗阻性黄疸诊断中的应用价值

【目的】探讨磁共振胰胆管成像(MRCP)对梗阻性黄疸的诊断价值。【方法】对165例经手术病理证实的结石,良性狭窄,壶腹癌,胰头癌,胆管癌,肝癌的梗阻性黄疸患者MRCP检查资料进行回顾性分析。【结果】恶性肿瘤77例,结石57例,炎症19例,胆总管蛔虫3例,胆总管囊肿9例。MRCP能清晰地显示正常胰胆管树的结构,能直观地显示胰胆管扩张和梗阻的部位、形态、范围,其检出率和定位准确率为100%,定性准确率为93.3%。【结论】MRCP对梗阻性黄疸定位,定性诊断准确,特别是对结石的诊断,能清楚地显示梗阻部位、梗阻原因、病变形态、病变与周围结构的关系及病变性质。     

快速自旋回波磁共振胰胆管造影与内窥镜逆行胰胆管造影在梗阻性黄疸的对照研究

目的:分析快速自旋回波磁共振胰胆管造影(Turbo SE MRCP)与内窥镜逆行胰胆管造影(ERCP)在梗阻性黄疸的应用价值。方法:对38例胆道梗阻患者进行了MRCP检查后,又进行了ERCP检查,对其影像所见进行了对照分析,所有病例均经手术或病理证实。结果:MRCP和ERCP对胆道梗阻的定位诊断正确率分别为100%和97%,MRCP的定性诊断正确率为85%,ERCP的定性诊断正确率为94%。结论:MRCP和ERCP对梗阻性黄疸都有准确的定位诊断价值,ERCP的定性诊断价值高于MRCP,而MRCP对一些恶性梗阻的定量诊断有价值。     

Is there a difference in diagnostic accuracy and clinical impact between endoscopic ultrasonography and magnetic resonance cholangiopancreatography?

BACKGROUND AND STUDY AIMS: It is still unknown whether there is a difference in diagnostic accuracy and clinical impact between endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP). PATIENTS AND METHODS: The test performance and potential clinical impact of EUS and MRCP, had each investigation been performed as the first examination method, were compared prospectively in 163 patients admitted for and examined by endoscopic retrograde cholangiopancreatography (ERCP). RESULTS: The accuracies of EUS and MRCP were 0.93 and 0.91, respectively (no significant difference, P > 0.05). Had EUS or MRCP been performed as the first investigation in the 75 patients who had a presumed high probability for needing therapeutic ERCP, only 15 and nine patients, respectively, would have avoided ERCP. In this group of patients, one patient needed other diagnostic investigations following EUS compared with 11 patients following MRCP ( P = 0.004). For the 57 patients with an intermediate probability of needing endoscopic therapy, EUS and MRCP would have spared 37 and 38 patients, respectively, from the need to have an ERCP. In 31 patients with a presumed low risk of needing endoscopic therapy, 30 and 29 patients would have been spared from ERCP had EUS and MRCP, respectively, been performed initially. CONCLUSIONS: There was no difference in the diagnostic accuracy and clinical impact between EUS and MRCP in the majority of the patients. The impact of EUS or MRCP on the ERCP workload was highly dependent on the presumed probability of needing endoscopic therapy.     

Potential impact of magnetic resonance cholangiopancreatography on endoscopic retrograde cholangiopancreatography workload and complication rate in patients referred because of abdominal pain

BACKGROUND AND STUDY AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) has a significant mortality, morbidity, and failed cannulation rate. Magnetic resonance cholangiopancreatography (MRCP) is a safer, noninvasive method of imaging the pancreaticobiliary tree. A substantial number of patients are referred for ERCP because of abdominal pain, a high proportion of whom have normal ducts or pathology not requiring interventional ERCP. The aim was to assess the potential impact of MRCP on overall ERCP workload and patient outcome if MRCP were the primary investigation in patients referred for ERCP because of abdominal pain. PATIENTS AND METHODS: 1758 consecutive ERCPs performed in 1148 patients over a 3-year period in a single tertiary referral center in the pre-MRCP era were reviewed. Cannulation failure, ERCP findings, need for follow-up ERCP and all 30-day major complication rates were analyzed with regard to clinical indications. RESULTS: The overall workload comprised 1108 (63 %) successful initial ERCPs, 188 (11 %) failed cannulation attempts and 462 (26 %) follow-up ERCPs. Of the patients, 299 (27 %) had normal ERCP findings, 331 (30 %) had choledocholithiasis and 246 (22 %) had strictures. lf MRCP had been used as the primary imaging investigation in the 451 patients (39 %) referred for ERCP because of abdominal pain, we estimate that 197 patients (44 %) would have avoided ERCP, and the overall ERCP workload would have been reduced by 13 %. Initial MRCP in suspected gallstone pancreatitis and certain miscellaneous groups, it was estimated, would have further decreased ERCP workload by 9 %. Four of 40 major ERCP-related complications (3.5 %) and one of four ERCP-related deaths (0.35 %) would potentially have been avoided. CONCLUSIONS: Initial MRCP in patients referred with abdominal pain would potentially have avoided ERCP in 44 % of cases, reduced ERCP workload by 13 % and significantly reduced patient morbidity and mortality. The relatively small reduction in ERCP workload among these patients reflects the fact that over half of them had probable sphincter dysfunction, a significant proportion of whom might have benefited from biliary manometry and/or endoscopic intervention despite a normal MRCP. Furthermore, a small number of patients with calculi and subtle biliary and pancreatic strictures would be missed by this approach.     

ERCP与MRCP对胆胰疾病诊断的比较研究

目的评价磁共振胰胆管成像(MRCP)与经内镜胰胆管造影(ERCP)对胰胆疾病的诊断价值。方法对85例胰胆管疾病患者均进行ERCP和MRCP检查,并经手术和病理证实。结果85例MRCP与ERCP均获成功,其中两者诊断一致53例,不一致32例(37.6%,32/85),诊断一致的胆总管结石36例,肿瘤9例,其他8例。不一致32例中,MRCP诊断为肿瘤、结石32例,而ERCP诊断为结石或未见异常。结论MRCP诊断胆总管扩张的敏感性、准确性较高,对扩张的病因诊断尚不够理想,对胆总管较小结石的诊断不如ERCP敏感及准确,而且不能治疗,因此MRCP不能替代ERCP。     

非屏气MRCP对于胆道梗阻性疾病的诊断价值(附60例ERCP与MRCP比较)

目的：研究非屏气ＭＲＣＰ技术显示胆道病变的能力。方法：６０例胆道梗阻性疾病患者进行了前瞻性ＭＲＣＰ和ＥＲＣＰ检查。分析ＭＲＣＰ图像胆胰管显示情况，有无充盈缺损及梗阻，作出定性诊断，并与ＥＲＣＰ比较。结果：ＭＲＣＰ和ＥＲＣＰ分别显示了１００％和８８％的胆管结石。对肿瘤及其它胆道梗阻病变，ＭＲＣＰ显示病变部位和形态的作用与ＥＲＣＰ基本一致。总的定性诊断准确性ＭＲＣＰ为８５％，ＥＲＣＰ为８８％。结论：非屏气ＭＲＣＰ是诊断胆道梗阻性疾病的可靠方法。     

磁共振胰胆管成像在胰胆管疾病诊断中的应用探讨

目的：探讨磁共振胰胆管成像（ＭＲＣＰ）在胰胆管疾病诊断中的临床应用价值。方法：５４例胰胆管疾病病人行ＭＲＣＰ检查，同时行磁共振常规扫描。６例病人在ＭＲＣＰ检查后一周内行ＥＲＣＰ检查。１４例经手术和病理证实。ＭＲＣＰ采用重度Ｔ２加权ＴＳＥ快速成像序列，加用脂肪压抑技术，图像经三维最大信号强度投影（ＭＩＰ）后处理。结果：冠状位ＭＲＣＰ图像与ＥＲＣＰ图像相似，空间分辨率略逊于ＥＲ－ＣＰ，能较好地显示胰胆管疾病的病变部位、梗阻程度及梗阻两端的情况。结论：ＭＲＣＰ作为一种安全非侵入性影像学诊断技术，能较好地显示胰胆管系统的解剖和病理变化，无放射性损伤，不用造影剂，对ＥＲＣＰ检查失败者或显示不完全的病例ＭＲＣＰ能获得较为满意的胰胆管图像。与ＥＲＣＰ相辅相成，可提高胰胆管疾病的诊断水平     

Three-dimensional magnetic resonance cholangiopancreatography with respiratory triggering in the diagnosis of primary sclerosing cholangitis: comparison with endoscopic retrograde cholangiography

BACKGROUND AND STUDY AIMS: The purpose of this study was to evaluate the accuracy of respiratory-triggered three-dimensional magnetic resonance cholangiopancreatography (3D-MRCP) for the detection of primary sclerosing cholangitis (PSC) and to compare the specific findings of magnetic resonance cholangiography and endoscopic retrograde cholangiography in patients with PSC. PATIENTS AND METHODS: The MRCP findings were evaluated in 150 patients with clinical symptoms (progressive fatigue, pruritus followed by icterus) and/or elevated values for alkaline phosphatase and serum aspartate transaminase, and occasionally an elevated serum concentration of bilirubin as a sign of cholestasis, who were consecutively referred for magnetic resonance imaging. Two observers independently classified bile duct abnormalities and established the MRCP diagnosis in a consensus reading. The results of MRCP were compared with the definitive diagnosis, which was based on the clinical history and laboratory and histological data, as well as on endoscopic retrograde cholangio-pancreatography (ERCP) findings. In a second step, the observers compared the delineation of the biliary system and morphological findings using MRCP and ERCP in patients with confirmed PSC. RESULTS: Diagnostic examinations were obtained in 146 of the 150 MRCPs (97 %). The diagnosis of PSC was confirmed by clinical data and ERCP in 34 of these 150 patients (23 %). The sensitivity and specificity of MRCP for diagnosing PSC were 88 % (29 of 33) and 99 % (108 of 109), respectively. MRCP and ERCP yielded similar scores for the delineation of the biliary system (P = 0.2) in patients with PSC. However, different bile duct abnormalities leading to the diagnosis of PSC were depicted by MRCP and ERCP; more bile duct stenoses and pruning were seen with ERCP and more skip dilatation with MRCP (P < 10(-4)). CONCLUSION: In patients with PSC, MRCP is a highly sensitive method and its diagnostic accuracy is comparable to that of ERCP.     

MRCP对恶性胆道狭窄的诊断价值

目的：通过与ＥＲＣＰ／ＰＴＣ对比,评价ＭＲＣＰ对恶性胆道狭窄的定位、定性的准确性。材料与方法５７例恶性胆道狭窄患者,采用不屏气或屏气快速自旋回波（ＦＳＥ）序列扫描,对照ＥＲＣＰ或ＰＴＣ检查和病理结果,评价ＭＲＣＰ对恶性胆道狭窄征象的显示能力。结果：ＭＲＣＰ诊断恶性胆道狭窄的定位准确性分别为１００％和８７．８％,经统计学检验证实与ＥＲＣＰ／ＰＴＣ不存在显著性差异。对病变胆管截断、狭窄及管壁不规则等征     

Mucinous cystadenomas and intraductal papillary mucinous tumors of the pancreas in magnetic resonance cholangiopancreatography

BACKGROUND AND STUDY AIMS: In mucin-producing tumors of the pancreas, diagnosis using endoscopic retrograde cholangiopancreatography (ERCP) is limited to cystic formations that communicate with the main pancreatic duct. Magnetic resonance cholangiopancreatography (MRCP) is a new, sophisticated method which is currently under evaluation. The authors describe the usefulness of MRCP in diagnosis of mucin-producing tumors. PATIENTS AND METHODS: Six patients with mucin-producing tumors were investigated using MRCP and ERCP. Imaging was compared with surgery and histopathological examinations. RESULTS: Three patients were found to have mucinous cystadenomas (MC), two patients had intraductal papillary mucinous tumors (IPMT) and one patient had a cystadenocarcinoma. MRCP demonstrated the cystic formations in all patients. Magnetic resonance imaging (MRI) showed contrast-mediated enhancement of the cystic wall in patients with MC, and visualized the pancreatic ducts completely in patients with IPMT. ERCP failed to visualize the cystic lesion in one patient with MC of the pancreatic tail. Furthermore, ERCP showed evidence of IPMT in dilated main ducts with multiple filling defects but did not visualize the ducts completely. CONCLUSIONS: MRCP provides visualization of pancreatic ducts, extraductal variations, and cystic formations more completely than ERCP does. It avoids complications seen in ERCP. MRCP may replace ERCP in the evaluation of mucin-producing tumors of the pancreas.