肝胆特异性磁共振对比剂莫迪司的排泄特征及其临床应用

目的观察莫迪司排泄性磁共振胆管成像(MR cholangiography,MRCG)图像中胆管信号与直径的动态变化情况,探究莫迪司在胆管中的排泄规律及最佳排泄期扫描时间窗,以优化排泄期扫描序列,并进一步评价MRCG在胆道疾病中的应用价值。方法选择莫迪司MR增强检查时胆管于排泄期显影的患者30例,对比分析注射对比剂后1、2、3 h的排泄性磁共振胆管成像(MRCG-1h、MRCG-2h、MRCG-3h)图像中的左肝管、右肝管、肝总管和胆总管的信号值与直径的动态变化情况,对这3个排泄期的MRCG的胆管显示效果进行影像学评估,并对MRCG的临床应用价值进行初探。结果3个排泄期MRCG中所有胆管的信号值均显著高于增强T1~*像(P<0.05),MRCG-2h与MRCG-3h中肝总管与胆总管的信号值均显著高于MRCG-1h(P<0.05),MRCG-2h中肝总管的信号值显著高于MRCG-3h(P<0.05)。3个排泄期MRCG中左右肝管和肝总管的直径均显著大于MRCP(P<0.05),MRCG-2h和MRCG-3h中胆总管的直径均显著大于MRCP(P<0.05),MRCG-2h中左右肝管、肝总管和胆总管的直径显著大于MRCG-1h和MRCG-3h(P<0.05)。3个排泄期MRCG对右肝管的显示效果差异无统计学意义(P>0.05);MRCG-2h对胆管系统的总体显示效果均优于MRCG-1h和MRCG-3h(P<0.05)。结论理想的排泄期扫描时间是注射对比剂后2 h。莫迪司排泄性胆管成像作为无辐射损伤、无创性检查能够"一站式"完成胆道形态与排泄功能评估,对于胆道系统疾病具有潜在重要的临床应用价值。

Excretion characteristics and clinical application of hepatobiliary-specific MR contrast agent multihance

Objective To observe the dynamic changes in signal and diameter of bile ducts in the excretory MR cholangiography(MRCG)images,to explore the excretory regularity of multihance in bile ducts and the best MR scanning time window for the bile excretory phase,to optimize the scanning sequence of MRCG,and to evaluate the clinical application value of MRCG in the biliary tract diseases.Methods Totally 30 patients whose bile ducts were displayed in the excretory phase by enhanced MR examination with multihance were selected.The dynamic changes in signal and diameter of left hepatic duct,right hepatic duct,common hepatic duct and common bile duct in all three-phase MRCGs,including 1 hour(MRCG-1 h),2 hours(MRCG-2 h)and 3 hours(MRCG-3 h)after injection of multihance,were compared and analyzed.The display effect of bile ducts in all three-phase MRCGs were evaluated.Then the clinical application value of MRCG in the biliary tract diseases were explored.Results The signal values of all bile ducts in all three-phase MRCGs were significantly higher than those in enhanced T1~*images(P<0.05);the signal values of common hepatic duct and common bile duct in MRCG-2 h and MRCG-3 h were significantly higher than those in MRCG-1 h(P<0.05),and the signal value of common hepatic duct in MRCG-2 h was significantly higher than that in MRCG-3 h(P<0.05).The diameters of left and right hepatic ducts and common hepatic ducts in all three-phase MRCGs were significantly larger than those in MRCP(P<0.05);the diameter of common bile duct in MRCG-2 h and MRCG-3 h was significantly larger than that in MRCP(P<0.05);the diameters of left and right hepatic ducts,common hepatic ducts and common bile ducts in MRCG-2 h were significantly larger than those in MRCG-1 h and MRCG-3 h(P<0.05).The difference of all three-phase MRCGs in display effect of the right hepatic duct was not statistically significant(P>0.05);the overall display effect of biliary tract system in MRCG-2 h was superior to that in MRCG-1 h and MRCG-3 h(P<0.05).Conclusion The ideal scanning time window for bile excretory phase is 2 hours after injection of multihance.The excretory MRCG with multihance,as a non-radiative and non-invasive examination,can provide a one-stop evaluation of the morphology and excretory function of biliary tract in one-stop,and it has a potentially important application value in evaluation of biliary tract diseases.