MRCP在梗阻性黄疸定位与定性诊断中的作用

目的探讨MRCP在梗阻性黄疸病因诊断中的作用。方法回顾性分析有完整临床、病理资料的54例梗阻性黄疸患者MRCP、MRI资料，着重分析MRCP在梗阻定位方面的作用及其形态学特征，并评价其在良恶性病变鉴别诊断中的作用。结果MIP三维重建图像可显示胆管全貌，MRCP对54例胆系梗阻的定位诊断均与手术、内镜所见相符，定位准确率为100％。恶性病变中，9例肝门区胆管癌呈突然截断，梗阻端呈圆钝状或平直状，3例胆总管下段癌呈偏心性、不规则性狭窄；11例胰头癌中8例呈乳头状，3例呈偏心性、不规则性狭窄；6例十二指肠乳头腺癌中5例呈鸟嘴状，1例呈渐行性狭窄。良性病变16例结石梗阻端呈倒杯口状；9例胆总管下段炎性狭窄呈渐行性改变。结论MRCP可明确定位梗阻部位，并初步定性诊断；结合MRI平扫、动态增强资料可显著提高良恶性鉴别诊断正确率。

Role of MRCP in the diagnosis of the obstructive jaundice

Objective To evaluate the usefulness of MRCP in diagnosis of the obstructive jaundice.Methods Fifty-four patients with obstructive jaundice who had entire clinical and pathologic data and underwent MRI including MRCP were retrospectively studied,emphasizing on the location and morphologic feature,and the role in the differential diagnosis between benign and malignant obstruction.Strictures were described according to their imaging appearance(irregular or smooth margins,asymmetric or symmetric narrowing,abrupt narrowing or gradual tapering).Results On MRCP,the location of obstruction were demonstrated completely,and sensitivity,100%.Among the 29 cases of malignant biliary stricture,the shapes of distal common bile duct were meniscoid or blunted in 9 cases,bird beak in 5 cases,papillary in 8 cases,irregular and asymmetric in 6 cases,and tapered in 1 case.In 16 stone-related cases,ampullary stenosis was transoid-blunted on MRCP,and 9 cases of inflammatory stenosis was tapered.Conclusion MRCP was helpful to locate and diagnose obstructive jaundice.Both MRCP and MRI had a profound influence on the diagnostic algorithm between the benign and the malignant obstruction.