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与ERCP、PTC诊断胆道梗阻性疾病的对比研究

目的 :探讨磁共振胰胆管成像 (MRCP)加梗阻部位薄层扫描或增强扫描、内镜逆行胰胆管造影 (ERCP)、经皮肝穿刺胆道造影 (PTC)对胆道梗阻的诊断价值。材料和方法 :回顾性分析 42例临床怀疑胆道梗阻患者的MRCP资料 (包括薄层或增强扫描 ) ,并与 18例ERCP、9例PTC比较 ,所有病例均经手术病理证实。结果 :MRCP加梗阻部位薄层扫描或增强扫描对胆管梗阻诊断准确率为 90 .5 % ,ERCP为 88.9% ,PTC为 88.9%。结论 :MRCP加梗阻部位薄层扫描或增强扫描对胆管梗阻具有重要诊断价值。     

MRCP在梗阻性黄疸诊断中的应用价值

目的：探讨磁共振胰胆管造影（MRCP）对梗阻性黄疸的诊断价值。方法：60例梗阻性黄疸患者采用重T2加权MR水成像技术，采集资源影像后做最大信号强度投影（MIP）处理。结果：60例患者经过MRCP检查均满意的显示梗阻部位及胆管扩张程度，定位诊断准确率100％，定性诊断准确率为86．7％。结论：MRCP可以直观准确地显示胆管梗阻的部位和程度，结合MR常规SE序列和胰胆管成像的原始图像所见，定性诊断准确率较高，对梗阻性黄疸的诊断是一种有效、安全、可靠的方法     

磁共振胰胆管成像对恶性胆道梗阻的诊断价值

目的：评价磁共振胰胆管成像（MRCP）对恶性胆道梗阻性疾病的临床诊断价值，探讨肝外恶性胆道梗阻的MRCP、MRI诊断及鉴别诊断。方法：回顾性分析69例恶性胆道梗阻患者的MRI及MRCP表现，并与CT、US、直接胆道造影和手术病理结果对照。MRCP采用二维（2D）和／或三维（3D）屏气半傅立叶转换快速自旋回波（FASE）序列T2加权成像技术。结果：69例MRCP检查均一次成功，全部病例胰胆管显示满意，与直接胆道造影对照，二者所获图像极其相似。MRCP对恶性胆道梗阻定位诊断准确率为98．5％定性诊断准确率为95．6％。结论：MRCP对恶性胆道梗阻定位及定性诊断优于CT和US，是诊断恶性胆道梗阻的一种有效的非侵袭性的检查方法。     

磁共振胰胆管成像技术的临床应用研究

目的：探讨磁共振胰胆管成像（MRCP）对胰、胆管疾病的诊断价值。方法：采用快速自旋回波（FSE）重T2加权技术对221例患进行了MRCP检查。结果：221例患中，MRCP正确诊断良性病变134例和恶性病变75例，定性诊断和定位诊断准确率分别为94．6％（209／221）和100％（221／221）。对良、恶性病变定性诊断准确率分别为96．4％（134／139）和91．4％（75／82）。结论:MRCP对胰、胆管疾病具有极高的诊断准确率，是一种颇有应用前景的影像技术。     

低场强磁共振胰胆管水成像在胆道梗阻性疾病诊断中的应用

目的：评价低场强磁共振胰胆管水成像技术（MRCP）在胆道梗阻性疾病诊断中的应用价值。方法：对36例患者及10例正常志愿者行MRCP检查，并与B超、CT进行比较，其中胆管结石13例，胆管癌12例，胰头癌5例，十二指肠乳头壶腹癌1例，胆系感染性狭窄5例。结果：MRCP能清晰显示胆管的梗阻部位，定位诊断准确率达100％，梗阻定性诊断率88.9％，优于B超和CT检查。结论：MRCP对胆道梗阻性病变的定位、定性诊断准确率明显提高，是此类病变可首选的检查方法。     

MSCT阴性法胰胆管造影诊断低位胆管梗阻的评价

目的：探讨多层螺旋CT(MSCT)阴性法胰胆管造影(N—CTCP)对低位胆管梗阻性疾病的诊断价值。方法：对30例胆管结石、胆管癌、胰头癌、壶腹癌进行N-CTCP成像，并与内窥镜逆行胰胆管造影(ERCP)及手术病理结果对照。结果：30例均一次屏气完成扫描，N—CTCP成像显示胰胆管满意，MinIP对判断胆管梗阻和定位诊断准确率为100％，定性诊断准确率为78．5％。结论：N-CTCP对低位胆管梗阻性疾病定位准确．对胆管结石及恶性胆管梗阻判断有较高准确性。结合轴面源像(ASI)可提高对胆管细小结石的定性诊断。     

MRCP对梗阻性黄疸诊断价值的探讨

目的探讨磁共振胰胆管成像(MRCP)对梗阻性黄疸疾病的诊断价值。方法回顾性分析经手术或ERCP病理证实的梗阻性黄疸患者资料119例。该119例梗阻性黄疸患者用西门子1.5T超导型磁共振成像仪行常规MRI及MRCP检查。常规MRI包括轴位T1WI、T2WI及T2trufi冠状位扫描;MRCP检查包括3DMRCP和二维厚块MRCP检查。结果良性病变98例,其中胆系结石80例,胆管炎性狭窄12例,胆总管蛔虫4例,胆总管囊肿2例。恶性病变21例,其中胆管癌11例,壶腹癌3例,胰头癌7例。MRCP能清晰地显示正常胰胆管树结构,能直观地显示胰胆管扩张和梗阻的部位、形态、范围,对梗阻性胆道疾病的定位诊断准确率为100%,定性诊断准确率为94%。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、原因、病变形态、病变与周围结构的关系及周围病变性质,为临床手术方案提供可靠依据。     

肝门部胆管梗阻性疾病的影响诊断

目的：评价螺旋CT（SCT）和磁共振胰胆管造影（MRCP）在肝门部胆管梗阻性病变的稞诊断价值。材料和方法：收集16例经SCT或MRCP显示肝门部胆管梗阻的病例进行回顾性分析,并与手术和病理结果对照。结果：SCT或MRCP对全部16例病例胆管梗阻程度和定位诊断准确率为100%,定性诊断SCT为80%,MRCP为83.3%。结论：SCT和MRCP对肿瘤局部浸润和肝内局限性转移高于MRCP,MRCP对于阴性结石以及局部血管推移和累敏感性较高。     

单激发放射状MRCP在胆道梗阻中的应用价值

目的:探讨单次激发放射状磁共振胰胆管水成像(SSH/MRCP/RAD)在胆道梗阻中的应用价值。方法:对55例经病理证实的胆道梗阻性疾病的MRCP成像资料进行回顾性的分析,MRCP采用单次激发放射状自旋回波序列技术。其中肝癌2例,肝门转移癌4例,肝门胆管癌12例,肝内外胆管结石2例,胆管癌7例,胰头癌7例,壶腹癌5例,十二指肠降部腺癌2例,胆总管结石10例,炎症3例,先天胆管囊肿1例。结果:55例MRCP检查均一次成功,肝内外胆管显示率100%,主胰管显示率85%。定位诊断100%,定性准确率86.8%,良性为85.7%,恶性92.3%。结论:SSH/MRCP/RAD是较为理想的成像技术,结合源图定性诊断特异性高,在临床有较大的应用价值。     

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     

磁共振胰胆管造影在肝外胆道梗阻性疾病中的应用价值分析

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 2 9例肝外胆管梗阻性疾病 (肝外胆管结石 9例 ,恶性胆管梗阻 18例 ,胆囊周围淋巴结反应性增生 1例 ,胆囊结石 1例 )进行MRCP检查 ,并与术后病理结果或临床综合诊断对照分析。MRCP采用屏气单次激发半数傅立叶变换的TSE序列 (HASTE) ,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 2 9例MRCP检查均一次成功 ,2 7例胆胰管显示满意。MRCP对肝外胆管梗阻性疾病的定位诊断率为 10 0 % ,定性诊断率为 79.3 %。结论　MRCP检查成功率高 ,对肝外胆管梗阻的定位诊断准确 ,结合原始图像和常规MRI扫描 ,对肝外胆管结石和恶性胆管梗阻的定性诊断也有较高的准确性     

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 trans-abdominal ultrasound in the detection of choledocholithiasis, and to compare bile duct stone characteristics using endoscopic retrograde cholangiopancreatography (ERCP), MRCP and ultrasound. MATERIALS AND METHODS: Of 191 consecutive patients referred for diagnostic ERCP, choledocholithiasis was diagnosed in 34 patients using direct cholangiography. The latter took the form of ERCP (n = 29), intraoperative cholangiography (n = 3) or percutaneous transhepatic cholangiography (n = 2). All patients underwent MRCP and ultrasound examinations and their findings for choledocholitiasis were compared with those at direct cholangiography. Finally, in the 29 patients with choledocholithiasis diagnosed under ERCP, stone characteristics were compared across the three investigations of ERCP, MRCP and ultrasound. RESULTS: Compared with direct cholangiography, MRCP showed 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. Ultrasound showed a sensitivity, specificity and diagnostic accuracy of 38%, 100% and 89%, respectively, in the diagnosis of choledocholithiasis. ERCP revealed a greater number of stones and these were more proximally distributed within the bile ducts when compared to MRCP. CONCLUSIONS: MRCP is highly accurate in the diagnosis of choloedocholithiasis and has the potential to replace diagnostic ERCP. MRCP underestimates the number of bile duct stones present.     

Navigator-triggered isotropic three-dimensional magnetic resonance cholangiopancreatography in the diagnosis of malignant biliary obstructions: comparison with direct cholangiography

PURPOSE: To compare the diagnostic accuracy of navigator-triggered isotropic three-dimensional (3D) MR cholangiopancreatography (MRCP) using parallel imaging for malignant biliary obstruction with direct cholangiography. MATERIALS AND METHODS: A total of 23 patients with malignant biliary obstruction underwent MRCP and endoscopic retrograde cholangiopancreatography (ERCP)/percutaneous transhepatic cholangiography (PTC). Two observers retrospectively evaluated 3D-MRCP and ERCP/PTC and recorded the level of obstruction and extent of tumor along with their confidence. The quality of images and morphologic appearance of stricture were also evaluated by two reviewers. The results of MRCP and ERCP/PTC were compared with surgical and histopathological data. RESULTS: 3D-MRCP was of diagnostic quality and free of artifacts in all patients, whereas ERCP/PTC examinations failed in three patients. For the evaluation of level of obstruction, there was no statistical significance between 3D-MRCP and ERCP/PTC. 3D-MRCP was superior to ERCP/PTC in the assessment of anatomical extent of hilar bile duct involvement, but did not show statistical significance. The accuracy of 3D-MRCP in determining tumoral extent of hilar cancer was higher than that of ERCP/PTC, but it was not statistically significant. The image quality of 3D-MRCP was superior to ERCP/PTC. There was good agreement between morphologic appearance at MRCP and those at ERCP/PTC. CONCLUSION: 3D-MRCP can accurately assess the level of obstruction and extent of tumor in patients with malignant biliary obstruction.     

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.     

磁共振胰胆管成像对诊断胆胰系统疾病的临床应用价值

目的评价磁共振胰胆管成像(MRCP)技术在胆胰系统疾病诊断中的应用价值.方法68例患者进行了MRCP检查,其中正常对照组11例,各种胰胆管病变组57例.扫描使用ELSCINTSGR2.0T超导磁共振成像仪,体线圈及呼吸门控触发技术.平扫采用自旋回波(SE)常规成像;MRCP采用快速自旋回波(FSE)重T2加权像进行薄层扫描.所得图像用最大强度投影法(MIP)进行三维(3D)重建.结果MRCP能清晰显示胰胆管的解剖结构,对胆道梗阻程度和梗阻部位判断的确诊率达100%,梗阻原因的确诊率达91.2%.结论MRCP检查的成功率高,胰胆管解剖结构显示清晰,适应于各种胰胆管疾病的诊断,可作为该系统疾病诊断的首选方法     

Malignant obstructive jaundice: comparison of MRCP and ERCP in the evaluation of distal lesions

PURPOSE: To compare the diagnostic accuracy of MR cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of malignant stenosis of the distal common bile duct. MATERIALS AND METHODS: Twenty-one patients (12 males and 9 females, mean age 62 years) with a clinical suspicion of malignancy of the distal biliary tract and pancreatic head underwent tomographic RM evaluation and diagnostic MRCP, followed by diagnostic and, where possible, therapeutic ERCP. The images obtained with ERCP and MRCP were reviewed blind by two experts who evaluated the presence, site, signal features and locoregional extension of the tumours. Histology performed by brushing or biopsy during ERCP and after surgical resection provided the standard of reference for all 21 patients. RESULTS: CPRM correctly identified the presence and site of the distal biliary stenosis in 21/21 (100%) cases, as well as allowing evaluation of the upper abdomen by associating it with conventional MRI. ERCP, instead, allowed detection of the presence and site of biliary stenosis in 20/21 (95%) cases. DISCUSSION AND CONCLUSIONS: ERCP may have some limitations as regards identification of distal bile duct stenosis in cases of critical stenosis. The non-invasive nature and panoramic capabilities of MRCP and the fact that no contrast material is needed make MRCP the examination of reference in the diagnosis of malignant stenosis of the distal bile duct, also thanks to its ability to visualise the entire biliary tree in the presence of critical strictures of the common bile duct. The rationale for the use of ERCP lies in the possibility of taking histological samples and performing minimally invasive surgical interventions.     

A prospective comparison of magnetic resonance cholangiopancreatography with endoscopic retrograde cholangiopancreatography in the evaluation of patients with suspected biliary tract disease.

AIM: To determine the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) compared with direct cholangiography in the detection of biliary tract disease. PATIENTS AND METHODS: MRCP was performed in 100 patients in whom direct cholangiographic correlation (ERCP, n = 98; PTC, n = 9; intraoperative cholangiography, n = 3) was available for comparison. The MRCP examinations were performed using a two-dimensional multi-slice, fast spin echo (FSE) technique and a local surface coil. The diagnoses at direct cholangiography were choledocholithiasis in 30 patients, benign and malignant strictures in 28 patients and normal bile ducts in 42 patients. The nature of the strictures (benign, n = 2; tumour, n = 18; lymphnode recurrence, n = 3; unknown histology, n = 5) was determined by one or more of the following procedures: surgery (n = 8), biopsy (n = 15), cytology (n = 6) and cross-sectional imaging/follow-up findings (n = 3). RESULTS: MRCP diagnosed choledocholithiasis with a sensitivity of 93%, specificity of 99% and accuracy of 97 %. It resulted in two false-negative and one false-positive findings when compared with direct cholangiography. MRCP accurately diagnosed the presence and level of strictures in all patients. The overall sensitivity, specificity and accuracy of MRCP in the detection of bile duct lesions were 97%, 98% and 97%, respectively. CONCLUSION: MRCP has a high diagnostic accuracy when compared with direct cholangiography in the detection of bile duct disease.     

Role of magnetic resonance cholangiopancreatography in diagnosing choledochal cysts: Case series and review

AIM:To determine the merits of magnetic resonance cholangiopancreatography(MRCP) as the primary diagnostic test for choledochal cysts(CC’s).METHODS:Between 2009 and 2012,patients who underwent MRCP for perioperative diagnosis were identified.Demographic information,clinical characteristics,and radiographic findings were recorded.MRCP results were compared with intraoperative findings.A PubMed search identified studies published between 1996-2012,employing MRCP as the primary preoperative imaging and comparing results with either endoscopic retrograde cholangiopancreatography(ERCP) or operative findings.Detection rates for CC’s and abnormal pancreaticobiliary junction(APBJ) were calculated.In addition detection rates for clinically related biliary pathology like choledocholithiasis and cholangiocarcinomas in patients diagnosed with CC’s were also evaluated.RESULTS:Eight patients were identified with CC’s.Six patients out of them had typeⅣCC’s,1 had type I and 1 had a new variant of choledochal cyst with confluent dilatation of the common bile duct(CBD) and cystic duct.Seven patients had an APBJ and 3 of those had a long common-channel.Gallstones were found in 2 patients,1 had a CBD stone,and 1 pancreatic-duct stone was also detected.In all cases,MRCP successfully identified the type of CC’s,as well as APBJ with ductal stones.From analyzing the literature,we found that MRCP has 96%-100% detection rate for CC’s.Additionally,we found that the range for sensitivity,specificity,and diagnostic accuracy was 53%-100%,90%-100% and 56%-100% in diagnosing APBJ.MRCP’s detection rate was 100% for choledocholithiasis and 87% for cholangiocarcinomas with concurrent CC’s.CONCLUSION:After initial ultrasound and computed tomography scan,MRCP should be the next diagnostic test in both adult and pediatric patients.ERCP should be reserved for patients where therapeutic intervention is needed.