单次激发快速半傅立叶胰管造影68例分析

目的 探讨HASTE MRCP对胰、胆管疾病的临床诊断价值,分析在MRCP中,半傅立叶单次激发快速自旋回波序列(HASTE)与其它影像学检查比较所具有的优越性。方法 使用Siemens 1．5T vision Plus扫描仪,采用自控阵表面线圈,加脂肪抑制和图像预饱和技术,以HASTE序列重佗加权相多层扫描,进行三维重建,多角度多方位观察。结果本组胆系结石25例中,胆总管结石14例,肝内胆管结石8例;胆管良性梗阻14例,表现为胆总管近端扩张,远端逐渐变细,边缘光滑,全层无中断,呈不全梗阻,即“管道穿通征”阳性;胆管恶性梗阻28例,梗阻端形态以截断状最多见,其次为乳头状和鼠尾症。结论HASTE成像速度快,空间分辨率高,是目前理想的MRCIF,成像序列;HASTEMRCP作为无创性技术,能完整显示胰胆管系统结构,优于ERCP和PTC,对梗阻性疾病的定性和定位诊断率较高,恶性梗阻的胆管扩张程度较良性梗阻重,且“双管症”仅见于恶性梗阻,“管道穿通征”见于良性梗阻,可作为鉴别良恶性梗阻的重要指征。

HASTE MRCP: Analysis of 68 patients

Objective To evaluate magnetic resonance cholangiopancreatography(MRCP) in the diagnosis of the biliary obstructive diseases and pancreas diseases and compare half-Fourier acquisition single-shot( HASTE) sequence with other sequences and other simulacrum examination methods. Methods 68 patients with pancreaticobiliary duct diseases underwent MRCP on Siements 1.5T Vision Plus scanner a heavily T2-weighted HASTE was done during a breath-hold. The source images were postprocessed on three-dimensional workstation and were observed multiangularly and multidirectly. All were verified by the diagnosis of ERCP or surgical findings and pathology. The finding of MRCP images were analyzed and compared with US, CT, ERCP or PTC . Results Benign obstructions show dilatation near point of common bile duct( CBD) , then turn into stenosis in distant point of CBD and tend to have smooth borders with tapered margin,being not interrupted.It was called as "Duct-penetrating Sign .It was most commonly that malignant obstructive ends presented "cut-off-form and "rat-tail" sign.The sensitivity, specificity and accuracy of MRCP were 91% ,96.5% ,94% respectively in detecting benign and malignant obstructions. The diagnostic accuracy of MRCP was 95% , the same as ERCP (90% ) , but obviously superior to CT and US( P < 0. 05) . Conclusion HASTE with rapid imaging method and high spatial resolution is the optional noninavasive technique with excellent accuracy in the diagnosis of biliary obstruction and their causes. The degree of biliary dilation, the pattern of obstructive ends and the "Double Duct Sign " Duct-Penetrating Sign could be served as the signs of differentiating benign and malignant obetruction.