MRCP 2D FASE序列对胆道术后病变的诊断价值

目的 评价磁共振胆胰管成像（MRCP）二维快速自旋回波序列（2D FASE）对胆道术后并发症的诊断价值。资料与方法 对72例胆道术后（胆囊切除术48例，胆总管探查术8例，肝管空肠吻合术16例）出现不明原因发热、黄疸、右上腹痛等症状患者进行MRCP检查，由2位放射科医生阅片，着重观察是否存在残余胆囊、胆管狭窄、胆道结石、吻合口狭窄等术后并发症，并与直接胆管造影、手术和病理结果对照分析。结果 MRCP 2D FASE对残余胆囊的敏感性、特异性、阳性预测值、阴性预测值、准确率分别为92．3％、91．7％、92．3％、97．1％、95．8％；对胆管狭窄分别为90．9％、97．8％、90．9％、97．8％、96．4％；对胆道结石分别为79．2％、100％、100％、90．6％、93．1％；对胆管扩张均为100％；对胆肠吻合口定位准确率为100％；对吻合口狭窄诊断的准确率为87．5％。结论 MRCP 2D FASE序列是诊断胆道术后病变的一种准确、非侵入性的检查方法。

Evaluation of MRCP 2D FASE Sequence in the Postoperative Study of Biliary Ductal System

Objective To evaluate MR Cholangiopancreatography (MRCP) using two dimensional fast spin echo sequence (2D FASE) in the study of postoperative disorders of biliary ductal system.Materials and Methods MRCP 2D FASE was performed in 72 patients who developed unexplained fever, right upper quadrant pain and jaundice after the surgery of biliary ductal system. The MRCP films were interpreted by two radiologists, focusing on whether the postsurgical disorders, such as residual gallbladder, stenosis of biliary tract, biliary calculi and anastomostic stenosis, existed or not. The results were compared with the direct cholangiographic, surgical and pathological findings.Results The sensitivity, specificity, positive predictive value, negative predictive value and accuracy for residual gallbladder were 92.3%, 97.1%, 92.3%, 97.1% and 95.8%, respectively, for ductal stricture were 90.0%, 97.8%, 90.9%, 97.8 and 96.4%, for intraductal stone were 79.2%, 100%, 100%, 90.6% and 93.1%, respectively, while for ductal dilatation all were 100%. The accuracy for localizing the choledochoenteric anastomosis was 100%, while the accuracy for detecting the anastomostic stenosis was 87.5%.Conclusion 2D FASE MRCP is an effective and non invasive technique in diagnosing postoperative disorders of biliary system.