0.5 T MR单激发快速自旋回波在胆系梗阻性病变诊断中的应用

目的评估0.5 T MR单激发半傅立叶采集快速自旋回波胰胆管水成像(HASTE-MRCP)的定位及定性准确性,并与三维快速自旋回波胰胆管水成像(3D-TSE-MRCP)进行比较.方法所有95例病人均行HASTE-MRCP及结合呼吸门控的3D-TSE-MRCP检查及最大信号强度投影(MIP)(设备为Philips 0.5 T T5-NT 磁共振成像系统).分析95例患者的胆管解剖显示情况、病变显示情况并与手术结果比较.结果 HASTE-MRCP胆总管及1～3级胆管的显示率为100.0%,4～5级胆管为94.7%,胆囊为74.1%,胰管为63.2%;结石部位显示100.0%,恶性病变及术后狭窄显示率100.0%.与3D-TSE-MRCP比较,对4～5级胆管、胆囊颈及结石,尤其泥沙样结石的显示率更高,统计学上两者间差异有显著性意义(χ2 值分别为3.92、6.62、11.76 及29.93,P<0.05 或<0.01);对恶性病变及术后狭窄的显示率均为100.0%.结石主要表现为胆道内呈低信号的"充盈缺损";恶性病变则表现为截断及梗阻征象,并可显示软组织轮廓.结论 HASTE-MRCP是优秀的胰胆管超快速成像技术,在0.5 T MR 也能非常好的运用;比较结合呼吸门控的3D-TSE-MRCP ,HASTE-MRCP在重症病人成像或显示小结石及泥沙样结石上有明显优势,建议对急诊、重症及临床疑为结石的病人,首先考虑选择HASTE-MRCP技术.

The role of single-shot TSE imaging at 0.5 T MR in the diagnosis of biliary obstructive diseases

Objective To evaluate the diagnostic accuracy of half-Fourier single-shot TSE MR cholangiopancreatography (HASTE-MRCP) of 0.5 T MR scanner, and to assess its imaging advantage and clinical value by comparing with 3D-TSE-MRCP MIP. Methods All 95 patients were examined by HASTE-MRCP and 3D-TSE-MRCP with respiratory-triggering (Philips 0.5 T T5-NT). The results, including anatomies and diseases, were evaluated after operation. Results By HASTE-MRCP, common bile ducts, 1-3 branches of hepatic ducts, gallbladder, and pancreatic ducts were demonstrated in 100.0%, 94.7%, 74.1%, and 63.2% of the cases. Stones, malignant diseases, and postoperative stenosis were revealed in 100.0% of the cases. Compared with 3D-TSE-MRCP, the demonstrating rates of 4-5 hepatic ducts,neck of the gallbladders,and calculi,especially mud calculi, were higher in HASTE-MRCP, and there was significant difference between the two ways. Stones displayed as low signal in the bile ducts. Block obstruction and mass contour were revealed in malignant diseases. Conclusion Comparing with 3D TSE-MRCP, HASTE-MRCP was better and faster, especially in serious patients or in cases with small and mud calculus.