高位胆道梗阻的CT与MRI、MRCP诊断价值

目的　探讨CT、MRI和MRCP对高位胆道梗阻的临床诊断价值。方法　对 12例高位梗阻 (恶性 11例 ,良性 1例 )进行了常规MRI、2DFSE序列MRCP检查 ,其中 10例恶性病变进行了CT检查 (平扫 7例 ,增强 3例 )。结果　CT、MRI和MRCP对高位梗阻定位诊断准确率分别为 90 %、92 %和 10 0 % ,定性诊断准确率分别为 80 %、83%和 6 7% ,MRI +MRCP定性诊断准确率提高到 92 %。10例恶性梗阻CT检查显示肿物 5例 ,胆总管环形增厚 3例。 12例MRI扫描显示肿物 8例 ,肝内转移 2例。MRCP显示梗阻近端形态较为特征 ,截断状以肝癌多见 ,锥状以胆管癌和转移癌多见 ,漏斗状见于良性病变。MRCP显示多发狭窄的长度和范围。结论　CT和MRI对高位梗阻具有同样重要的定性诊断价值。MRCP确定病变部位和范围具有独特的价值。MRI和MRCP结合可提高定位和定性诊断正确率

The Value of CT,MRI and MRCP in Diagnosis of High Level Biliary Obstruction

Objective To evaluate the clinical value of CT,MRI and MRCP in diagnosis of high level biliary obstructive diseases.Methods Conventional MRI and 2D FSE MRCP were performed in 12 patients,including 11 cases of malignant obstruction and 1 case of benign obstruction.10 patients with malignant diseases were examined by CT,including contrast enhanced CT in 3.Results The accuracy of diagnosing location of high level obstruction with CT,MRI and MRCP were 90.0%,92.0%,and 100.0% respectively.The accuracy of diagnosis of nature of high level obstruction were 80.0%,83.0%and 67.0% respectively,whereas the accuracy of that with both MRI and MRCP were 92.0%.CT demonstrated tumors in 5 and rim thicking of bile duct wall in 3 of 10 patients.MRI showed tumors in 8 and intrahepatic metastasis in 2 of 12 patients.The morphology proximal to the obstruction was more characteristic with "cut off-form" and "tapered-form",whereas the "cut off-form"often appeared in hepatocellular carcinoma and "tapered-form"in cholangiocarcinoma and liver porta metastasis.MRCP was capable of providing the length and extent of obstruction and multiple narrow.Conclusion The important value of CT diagnosis of nature of high level biliary obstruction is similar to that of conventional MRI,MRCP,having its advangtage,can determine the location and extent of the disorders.Conventional MRI in combination with MRCP can increase the accuracy of diagnosis of location and nation of the diseases.