MR/MRCP/MRA对胆胰管恶性阻塞性疾病术前诊断及治疗抉择的评价

目的 探讨现代影像学检查对胆胰管恶性阻塞性疾病术前诊断的准确性及临床应用价值。方法 对４４例胆胰管恶性阻塞性疾病患者进行磁共振成像（ＭＲ）、磁共振胆胰管造影（ＭＲＣＰ）以及磁共振动态增强血管显影（ＭＲＡ）检查，并与同期进行Ｂ超（Ｂ－us）、内窥镜逆行性胰胆管造影（ＥＲＣＰ）以及电子计算机断层扫描（ＣＴ）等检查结果对照。结果 ４４例患者中诊断为胰头部和壶腹周围癌者２８例，胰体尾部癌５例，肝胆管癌１１例，其定位准确率为８２％，定性准确率为７６％。Ｂ-us定位准确率、定性准确率分别为７３％和６８５，ＥＲＣＰ定位准确率、定性准确率分别为９６％和８４％。结论 ＭＲ／ＭＲＣＰ／ＭＲＡ对胆胰管恶性阻塞性疾病术前诊断的准确性优于Ｂ超、ＣＴ和ＥＲＣＰ，对胰胆管肿瘤转移和周围组织浸润，尤其是对肿瘤血管浸润可明确显示，其影像学结果对病变程度估计及指导临床治疗抉择有重要价值。

Value of MR/MRCP/MRA on preoperative diagonosis for patients with malignant obstruction of biliary and pancreatic duct

Objective　To evaluate the value of imaging means on preoprative diagnosis for patients with malignant obstruction of the biliary and pancreatic ducts.　Method　44 cases underwent preoperative MR/MRCP/MRA examination. The accurate rate of diagnosis was compared with that derived from B-us, CT and ERCP.　Results　28 of 44 cases were diagnosed as with pancreatic and periampullary carcinoma, 5 cases as with pancreatic body and tail carcinoma,11 cases as with biliary duct carcinoma. The accurate rates of MR/MRCP/MRA for tumor locating and cause were 100% and 96% respectively. Blood vessel invasion, adjacent organ infiltration and matastasis were detected preoperatively in 17 cases. In contrast, the accurate rate for tumor locating and cause were 82% and 76% with CT, 73% and 68% with B-us, 96% and 84% with ERCP. 　Conclusions　 MR/MRCP/MRA combined has advantage over B-us, CT and ERCP in preoperative diagnosis especially for detecting organ matastasis and blood vessel infiltration. It has an important value in the establishment of tumor staging and decision making of clinical therapy