磁共振3D-VIBE序列在肝门胆管癌术前评价的应用价值

目的探讨三维快速梯度回波T1加权磁共振成像序列（volumetric interpolated breath—hold examination，3D-VIBE）在术前评价肝门胆管癌的诊断价值。方法前瞻性纳入并经随后手术证实的31例肝门胆管癌患者术前行上腹部综合磁共振（magnetic resonance imaging，MRI）检查，序列包括快速自旋回波T2加权（T2 weighted，T2W）、二维（two dimension，2D）梯度回波T1加权（T1 weighted，T1W）平扫，2D磁共振胆胰管成像（magnetic resonance cholangiopancreatography，MRCP），Gd对比剂（Gd-DTPA）增强的3D-VIBE三期动态扫描和增强2DT1W（平衡期）。分析肿瘤的形态、胆管侵犯范围和有无血管侵犯，并比较3D-VIBE和2DT1W序列判断能否手术根治性切除肿瘤的可靠性。结果①3D-VIBE序列直接显示了所有31例病例的肝门部肿瘤，并准确判断形态学分类；8例浸润型肝门胆管癌病例在2D T1W序列增强图像上肿瘤未获直接显示（25．8％）。②根据Bismuth-Corlette分类法，3D-VIBE显示胆管纵向侵犯范围的准确性接近MRCP（93．5％），而常规2DT1w增强图像倾向于低估胆管侵犯范围（32．3％）。③3D-VIBE显示了更多的肝动脉、门静脉及其分支侵犯。④在判断本组肝门胆管癌病例能否手术切除方面。3D-VIBE序列阳性预测值为84．2％，准确性为90．3％；2DT1W序列分别为64．0％和71．0％。结论3D-VIBE在判断肝门胆管癌形态学类型、胆管纵向侵犯范围和手术切除性等方面优于其它MRI序列。

The Value of MRI 3D-VIBE Systems Applied to Preoperative Estimate of Hepatic Portal Cholangiocarcinoma

OBJECTIVE: To explore the diagnostic value of the system serial of three-dimensional spoiled gradient-echo T1-weighted MR imaging (three-dimensional volumetric interpolated breath-hold examination, 3D-VIBE) used to the preoperative assessment of hepatic portal cholangiocarcinoma. METHODS: 31 surgically confirmed patients with hepatic portal cholangiocarcinoma underwent the preoperative examination through MR imaging system serial that was including T2W, two dimension (2D) T1W plain scan, 2D magnetic resonance cholangiopancreatography (MRCP), and Gadolinium-enhanced 3D-VIBE triple-phase dynamic acquisitions followed by 2D T1W scanning at the equilibrium phase. Meanwhile, it was performed for focusing on assessing or judging the tumor morphological type, the longitudinal infiltration extent of the bile duct and the involvement of neighbor blood vessels. And the 3D-VIBE was compared with 2D T1W systems for assessing or judging the tumor resectability. RESULTS: (1) (3D-VIBE directly displayed the hepatic portal tumors and correctly classified the tumor morphological types in all patients, but 2D T1W systems missed to show 8 hepatic portal cholangiocarcinoma of periductal-infiltrating type (25. 8%); (2) According to Bismuth-Corlette classification, 3D-VIBE was closed to MRCP in accuracy (93.5%) for showing the longitudinal infiltration extent of tumor, but 2D T1W system serial underestimated (32.3%) the extent. (3) 3D-VIBE showed more involvement of the main trunk of hepatic artery, portal vein and their branches than 2D T1W systems did. (4) The positive predicting value and accuracy for assessing tumor resectability were 84.0% and 90.0% for 3D-VIBE system, as 64.0% and 71.0% for 2D T1W systems. CONCLUSION: 3D-VIBE system is superior to other MR imaging system serial in the preoperative assessment of the morphological type, the longitudinal infiltration extent and the tumor resectability of hepatic portal cholangiocarcinoma.