临床磁共振仿真胆管镜成像的初步研究

目的　探讨磁共振仿真胆管镜 (MRVC)技术及其临床应用价值。方法　 41例胰胆管疾病患者行冠状面二维快速自旋回波重T2 序列薄层无间隔扫描 ,在工作站用导航技术作内窥镜成像等后处理。 4例胆囊严重萎缩且充满结石者无法重建胆囊内窥镜影像。 12例获术中纤维胆管镜检查。结果　 10 0 % (4 1/ 41)段以上胆管、88 9% (32 / 36 )胆囊和 75 6 % (31/ 41)主胰管成功地获得了胆管镜样图像。MRVC对胰胆管疾病患者总检出率为 97 6 % (4 0 / 41) ,对胆石症患者敏感性达 96 7% (2 9/ 30 ) ,长径 2～ 2 0mm的胆管结石及其数目与状态得以清晰显示 ,结石和癌肿MRVC影像颇具特征。MRVC还准确显示了 7例最大信号强度投影漏检的小结石病变 ,结合常规MRI与源影像 ,其对胰胆管疾病诊断的准确性达 95 1% (39/ 41)。发现 1例 (2 4% )假阳性结果。结论　MRVC成像为无创性内镜样显示胆胰管解剖的有效手段 ,对胰胆管疾病有一定的诊断和鉴别诊断价值

MR virtual cholangioscopy: preliminary clinical application

Objective To evaluate the clinical usefulness of MRVC in comparison with choledochoscope. Methods Forty one patients with pancreatic bile duct diseases proved by surgery and pathology underwent MRVC, which were reconstructed by navigator software on the workstation using heavily T 2 weighted MR hydrography source data. MRVC of gallbladders were not created in 4 cases of atrophic cholecyst filled with stones shown on source images. Choledochoscope was done in 12 cases during the operation. Results MRVC was successfully reformed at 100% (41/41) of biliary tracts, 88.9%(32/36, 5 cases were of post cholecytectomy) of cholecysts, and 75.6%(31/41) of pancreatic tracts. The overall detectability of cases on pancreatic bile duct diseases was 97.6%(40/41), and the sensitivity of cholecystolithiasis was 96.7%(29/30). Stones ranging from 2 to 20 mm in diameter were all but in one sandy calculi case well depicted on MRVC images. There were some characteristic signs of calculi and carcinomas on MRVC. MRVC accurately demonstrated the nidi of small stones failed to be shown on MIP images in 7 cases. And the accuracy of MRVC on determination of pancreatic bile duct diseases was 95.1%(39/41). There was one false positive result(2.4%). Conclusion MRVC is a reliable noninvasive method for depicting the anatomical structures and abnormal changes of pancreatic bile ducts.