磁共振仿真内镜在胆总管梗阻性病变中的应用

目的：评价MR仿真内镜（MRVE）对胆总管梗阻性病变的诊断作用。方法：将61例行3D TSE MRCP检查的胆总管梗阻病例的原始图像资料传送至工作站，利用专用的仿真内镜软件进行仿真内镜，观察不同病变的仿真内镜表现。结果：所有61例均得到较好的仿真内镜图像，32例结石及7例壶腹癌基础上合并结石、壶腹癌11例、十二指肠乳头炎6例、胰头癌6例、胰腺炎4例均得到清楚的显示，同时有12例泥沙样结石MIP图像未见显示而仿真内镜上得到清楚的显示，但有1例胆道乳头状癌的诊断需结合平扫图像；MRVE的空间分辨率低、无法真正显示病变的色彩改变及无法显示粘膜的细微改变为MRVE的应用局限性。结论：MRVE能直观地显示扩张胆总管内表现及病变情况，MRVE结合MRCP可提高胆总管梗阻性病变的诊断准确性。

Application of MR virtual endoscopy in obstructive diseases of common bile duct

Objective:To evaluate the MR virtual endoscopy(MRVE) in the diagnosis of the obstructive diseases of common bile duct(CBD).Methods:61 patients with obstruction in CBD underwent MR imaging using the sequence of 3D TSE MRCP,and the raw data were sent to Philips' Easyvision workstation and postprocessed with virtual endoscopy (MRVE).Results:All MRVE images were good,and showed clearly calculi in CBD(n=32),ampullar cancer with concomitant stone(n=7),ampullar cancer(n=11),duodenal papillitis(n=6),pancreatic head carcinoma(n=6),pancreatitis(n=4),and sand like stone(n=12) not demonstrated on MIP images.However,one case with papillary carcinoma was diagnosed by the combined use of MRVE and plain MR images.Lower spatial resolution,not real colors and incapability of demonstration of the fine changes of the mucous membrane in CBD were the limitations of MRVE.Conclusion:MRVE may demonstrate directly the surface and lesions of CBD,and improve the diagnostic accuracy of obstructive diseases of CBD in combination with MRCP.