磁共振胰胆管造影诊断婴儿胆管先天性发育畸形

目的 探讨磁共振胰胆管造影(MRCP)检查在婴儿胆管先天性发育畸形及其与婴儿肝炎综合症(IHS)鉴别诊断中的应用价值.方法 对48例临床诊断胆管先天性发育畸形和IHS患儿行MRCP检查.将患儿的MRI征象与手术及病理检查结果进行对照.结果 MRI诊断婴儿胆管先天性发育畸形44例,MRCP表现为肝内外胆管未见显示44例,胆囊细小36例,胆囊未见显示5例,胆囊大小基本正常3例,肝脏增大37例;诊断婴儿肝炎综合症4例,MRCP表现为肝内外胆管均见显示4例,胆囊充盈3例,胆囊稍小1例,肝脏增大2例.44例MRI诊断的婴儿胆管先天性发育畸形,经手术及病理检查证实为胆管闭锁34例,胆管狭窄9例,胆泥淤积性胆管梗阻1例,误诊为胆管先天性发育畸形.MRI诊断的4例IHS患儿均经临床随访确诊为巨细胞病毒肝炎.MRCP对胆管先天性发育畸形诊断的敏感度100%,符合率97.92%,特异度为80.00%.结论 MRCP是诊断婴儿胆管先天性发育畸形敏感的检查方法,并在其与IHS的鉴别诊断中有一定的应用价值.

MR cholangiopancreatography in diagnosis of congenital bile duct abnormalities

Objective To investigate the value of MR cholangiopancreatography (MRCP) in diagnosis of congenital biliary malformations and differential diagnosis of infantile hepatitis syndrome (IHS). Methods Totally 48 patients of congenital biliary malformations and IHS patients underwent MRCP. MRI signs were compared with surgical and pathological results. Results MRI diagnosed infant congenital biliary malformations in 44 patients, MRCP showed no extrahepatic bile duct in 44 patients, small gallbladder in 36, no gallbladder in 5, normal gallbladder size in 3, and enlargement of the liver in 37 patients. HIS was diagnosed in 4 patients, MRCP showed bile ducts inside and outside the liver in 4 patients, gallbladder filling in 3, smaller gallbladder in 1, and enlargement of the liver in 2 patients. Surgical and pathological examination confirmed biliary atresia in 34 patients, biliary stricture in 9, as well as biliary sludge and silt biliary obstruction in 1 patient who was misdiagnosed as congenital biliary malformations. IHS was diagnosed with clinical follow-up of CMV hepatitis in all 4 patients. The diagnostic sensitivity of MRCP of biliary congenital malformation was 100%, coincidence rate was 97.92%, and the specificity was 80.00%. Conclusion MRCP is a sensitive inspection method in diagnosis of infants with congenital biliary malformations, and has certain value in the differential diagnosis of infantile hepatitis syndrome.