磁共振胰胆管成像诊断胰胆管合流异常的价值

目的 探讨磁共振胰胆管成像（MRCP）诊断胰胆管合流异常（APBDU）的价值。资料与方法 分析11例患者的MRCP、轴面T2WI及T1WI。测量共通管长度和胆总管宽度，观察APBDU的形式，以及胆管内有无结石和肿瘤等相关疾病。将观察结果与B超及内镜逆行性胰胆管造影（ERCP）检查和／或外科手术所见对照。结果 10例胆总管囊肿型APBDU包括胆管囊状扩张7例，梭形扩张3例；1例非囊肿型APBDU表现为胆总管轻度扩张。胆总管最大直径范围是12～90mm，平均34mm。APBDU的合流形式包括A型7例，B型4例，在MRCP图像测量的共通管长度范围是18～30mm，平均23mm。轴面T2WI显示胆总管或胰管突然蝌蚪或逗点样增粗5例。APBDU相关疾病包括胆囊／胆管结石6例，胆管肿瘤1例，胰腺炎5例。对7例切除的病变胆管和胆囊标本进行病理组织学检查，均有慢性炎症改变。结论 MRCP检查有助于发现和诊断APBDU，轴面T2WI和B超检查阴性结果不能完全排除本病。

Value of MR Cholangiopancreatography in Diagnosing Anomalous Pancreaticobiliary Ductal Union

Objective To investigate the diagnostic role of magnetic resonance (MR) cholangiopancreatography (MRCP) in evaluating the patients with Anomalous Pancreaticobiliary Ductal Union (APBDU).Materials and Methods 11 patients with APBDU were performed MR examination, including MRCP, axial T_1WI and T_2WI. Observing and measuring the length of common channel and the diameter of common bile duct (CBD), identifying the patterns of APBDU, and whether stone or tumor in the bile ducts was present or not. The findings on MRCP and axial T_2WI were compared with that of ultrasonography, endoscopic retrograde cholangiopancreatography (ERCP) and/or surgical operation.Results Among 11 patients, 10 cases of choledochal cysts included cystic dilatation in 7 and fusiform in 3 cases, 1 case of noncholedochal cyst presented as mild CBD dilatation. The diameter range of dilated CBD was 12-90 mm, mean 34 mm. The patterns of APBDU were type A in 7 and type B in 4 cases, the length of common channel measured on MRCP ranged from 18 to 30 mm, mean 23 mm. Abrupt comma like enlargement of CBD or main pancreatic duct in the head of the pancreas outside the duodenal wall indicated the sign of APBDU as observing on sequential axial T_2WI in 5 cases. The diseases associated with APBDU, in addition to biliary duct dilatation, included cholangiocarcinoma in 1 case, pancreatitis in 5 cases, biliary stones in 6 cases, as well as chronic cholangitis and cholecystitis in 7 patients performed by surgical resection.Conclusion MRCP is useful for evaluating APBDU, failing to depict anomalous pancreaticobiliary junction on axial T_2WI and ultrasonography could not completely rule out the APBDU.