MR平扫及冠状面LAVA技术在低位胆管梗阻中的诊断价值

目的探讨磁共振平扫包括磁共振胰胆管造影(MRCP)]及冠状面快速三维容积动态增强(liver acqui-sition with volume acceleration,LAVA)在低位胆管梗阻诊断中的应用价值。资料与方法 64例低位胆管梗阻患者进行MR平扫、MRCP及冠状面LAVA检查,并将检查结果按三种方法分组:(1)平扫(包括MRCP);(2)冠状面LA-VA;(3)MR平扫+冠状面LAVA。对检查结果进行判读与分析,包括病变的定位及定性诊断,并与手术病理、经内镜逆行性胰胆管造影术(ERCP)或经皮肝内胆管造影术(PTC)结果对照,诊断结果进行McNemar检验,数据不足时采用精确概率法。结果依据最终诊断结果将所有病例分为三组:(1)肿瘤性低位胆管梗阻;(2)除结石外良性低位胆管梗阻;(3)结石性低位胆管梗阻。第一组病例中三种方法的定位诊断符合率无统计学差异,而MR平扫的定性诊断符合率低于冠状面LAVA及MR平扫+冠状面LAVA两种方法(P值分别为0.039,0.021)。第二组病例定位及定性诊断符合率无明显统计学差异。第三组冠状面LAVA诊断符合率低于其他两种方法(P=0.031)。结论冠状面LAVA对于肿瘤性低位胆管梗阻的定性诊断具有较大优势,MRCP在胆管梗阻疾病中,简便易行,可用于筛选检查,对于胆管结石的诊断有明显优势。

The Preoperative Evaluation of Plain MR and Coronal LAVA Technique in Low Level Biliary Obstruction

Objective To evaluate the role of plain MR imaging(including MRCP) and coronal LAVA technique in the preoperative diagnosis of low level biliary obstruction.Materials and Methods 64 patients with low level biliary obstruction were examined by plain MR,MRCP and coronal LAVA technique.The results were divided into 3 methods: method 1: plain MR images(including MRCP);method 2: coronal LAVA images;method 3: plain MR and coronal LAVA images.The results were compared with pathological,ERCP or PTC results.Results According to the final diagnosis,all patients were divided into 3 groups: group 1,malignant or tumor like obstruction;group 2,benign obstruction(stone excluded);groups 3,calculus obstruction.There was no statistical difference between 3 methods of position diagnosis in group 1,and the differential diagnosis of method 1 was lower than those of the others(P= 0.039,0.021).There was no statistical difference between 3 methods of position and differential diagnosis in group 2.There was statistical difference between method 2 and the others in group 3(P=0.031).Conclusion MRCP and coronal LAVA have similar value in the position diagnosis of low level biliary obstruction.Coronal LAVA technique has the advantage in the differential diagnosis of malignant or tumor like low level biliary obstruction,and MRCP has the advantage in diagnosis of stones.