胆道梗阻的磁共振胰胆管成像临床应用研究

目的:评价磁共振胰胆管成像(MRCP)技术对胆道梗阻的诊断价值。方法:对74例良恶性胰胆管梗阻性疾病患者。用自旋回波序列(SE)先进行常规腹部扫描,然后采用快速自旋回波序列(FSE)重T2加权薄层扫描法及半傅立叶采集的单激发厚层投射(SSFSE)技术进行MRCP检查。前者所得的原始图像在工作站进行后处理,后者无需进行后处理。结果:MRCP对胰胆管结构显示清晰,图像类似于直接胰胆管造影,可以清楚显示胆管梗阻的部位、范围、形态特点以及扩张或狭窄的胆管数量。恶性梗阻胆管末端形态主要有不规则截断状、圆钝乳头状、鸟嘴状、逐渐变窄形等,分别占44.7％、23.7％、26.3％和5.3％。根据Guibaud的分类方法将胆管扩张程度分为轻、中、重度,良性梗阻以轻、中度扩张为主,占85.3％(29/34);恶性梗阻多为中、重度扩张,约95％(38/40)。MRCP对梗阻检出和定位诊断的准确率达100％,对胆系结石诊断的准确性为95.8％,鉴别诊断良恶性梗阻的灵敏性为92.5％,特异性94.1％,准确性93.2％,对胰胆管梗阻性疾病总的诊断准确性为89.2％,高于超声检查(75.0％),两者相比具有显著差异(P<0.005)。结论:MPCP是显示胆道系统解剖和病理变化的新技术,具有无创性、安全可靠、诊断准确等优点,是诊断梗阻性黄疸的首选检查方法。

The clinical application of MR cholangiopancreatography in biliary diseases

Objective To evaluate the clinical application value of MR cholangiopancreatography (MRCP) in diagnosis of biliary obstructive diseases. Method MRCP was performed in seventy-four patients with benign or malignant obstructions of pancreatobiliary ducts on a 1.5-T ultraconductive scanner (GE Signa) with body coil and breath-gating trigger technique. MRCP was conducted after conventional MR imaging of the abdomen was performed with spin-echo sequences. Fast spin-echo (FSE) was used for heavily T2-weighted and images were later processed on workstation. Half-Foureier acquisition single-shot thick slice projection technique was also performed and the images don't need any post-processing. Results MRCP can exhibit the structure of pancreatobiliary tree so well that the images are close to direct cholangiography. The shapes of malignant obstruction conclude sudden interruption, dull papilla, bill shape and being narrow gradually with respective percentage of 44.7%, 23.7%, 26.3% and 5.3%. The ducts are dilatated as mild or moderate degree in benign obstructions, whereas moderate and severe degree in malignant with the percentage of 85.3% and 95% respectively. In the research, 100% diagnostic accuracy with MRCP can be reached in detecting and localizing obstructions. The diagnostic accuracy in diagnosing bile duct stone is 95.8%. The sensitivity, specificity and accuracy of differential diagnosis of benign and malignant obstructions are 92.5%, 94.1% and 93.2%, respectively. Also demonstrate an overall accuracy of 89.2% with MRCP in the diagnosis of bile duct obstructive diseases, which is significantly higher than 75.0%, the accuracy of ultrasonic examination (P<0.005). Conclusion As a simple, rapid, reliable and safe imaging technique, MRCP can provide important information for clinical diagnosis, especially in obstructive jaundice. It should be the best choice in diagnosis of pancreatobiliary diseases.