3D LAVA技术结合MRCP对壶腹周围癌的诊断价值

目的:探讨三维多期动态增强扫描(3D LAVA)结合胰胆管水成像(MRCP)对壶腹周围癌的诊断价值。方法:对42例壶腹周围癌患者在常规MR扫描基础上行3D LAVA多期动态增强及MRCP扫描,对原始图像进行3D MIP及MPR重建后处理,观察病变的直接?间接征象。结果:42例肿瘤中定性准确率为88%(37/42);其中正确诊断胆总管下段癌5例,胰头癌20例,壶腹癌4例,十二指肠乳头癌5例;胆总管下段癌定位于壶腹癌1例,胰头癌定位于壶腹癌2例,定位准确率为92%(34/37)。1例胰头癌、1例壶腹癌漏诊,漏诊率5%(2/42);2例胰头癌、1例十二指肠乳头癌误诊为炎症,误诊率7%(3/42)。总体诊断符合率为81%(34/42)。两者结合直接征象显示率达93%(39/42)。另外3D LAVA直观显示6例直径小于2cm的早期壶腹周围癌。结论:3D LAVA多期动态增强扫描结合MRCP对壶腹周围癌及其鉴别特别是早期微小病变具有较高的诊断价值。

The diagnostic value of periampullary carcinoma by 3D LAVA technique with MR cholangiopancreatography

Objective：To discuss the clinical application of hypotonic-MRCP（magnetic resonance cholangiopancreatography） combined with 3D LAVA dynamic multi-phase enhancement scanning in the synthetic diagnosis of periampullary diseases.Methods：Forty-two patients with periampullary diseases underwent MRI examination after duodenum was in hypotonicity,and then examined with hypotonicMRCP and 3D LAVA dynamic multi-phase enhancement scanning.The original images was reformed by MIP and MPR.The direct,indirect morphology manifest were observed.Results：In 42 cases,the qualitative accuracy was 88%（37/42）,which there were 5 cases as common bile duct carcinoma,20 cases as pancreatic cancer,4 cases as ampullary carcinoma,5 cases as duodenal cancer and,1 common bile duct cancer located in the ampullary carcinoma,2 pancreatic cancer located in the ampullary carcinoma,above all the positioning accuracy was 92%（34/37）.Overall diagnostic rate was 81%（34/42）.The combination of direct signs show 93%（39/42）.In addition 6 cases of early ampullary cancer less than 2 cm in diameter were displayed by 3D LAVA.Conclusion：Hypotonic-MRCP combined with 3D LAVA dynamic multi-phase enhancement scanning was effective diagnostic and value in the periampullary lesions and its identification,especially its extension of periampullary diseases.