肝门部恶性胆道梗阻的MRI．MRCP诊断价值

目的探讨MRI和MRCP对肝门部恶性胆道梗阻的临床诊断价值。方矬收集43例经手术稿理及临床随访证实的肝门部恶性胆道梗阻的MRl资料，其中包括肝细胞癌和肝内转移癌20例，肝门部转移瘤12例，肝门胆管癌11例。所有患者常规接爱T1WI、T2WI、T2／SPIR（脂肪抑制T2WI）及冠状位B-FFE检查后行MRCP检查。MRI、MRCP表现与临床手术、病理进行对照。结果MRI平扫显示肝内肿块20例（4例为肝内多发肿块），肝门部转移瘤包括肿大淋巴结12例。11例肝门胆管癌中显示浸润型8例，肿块型2例。MRCP显示梗阻端的形态特征，锥状26例，截断状13例，乌嘴状4例。肝内胆管呈树枝状和软藤状扩张。结论常规MRI和MRCP结合有助于肝门自E恶性胆道梗阻的定位和定性诊断以及临床治疗。

The Value of MRI and MRCP in Diagnosis of Malignant Hilar Biliary Obstruction

Objective To evaluate the clinical value of MRI and MRCP in malignant hilar biliary obstructive diseases. Methods MRI data of 43 patients with malignant hilar biliary obstructive diseases confirmed by surgery, pathology and clinical interview were analyzed retrospectively, including hepatocellular carcinoma and intrahepatic metastasis（20 casesl, hilar metastasis（I 2 cases） and hilar cholangiocarcinoma（ 11 cases）. All patients were in- cluded ira this study, conventional MRCP examination were perlbrmed following TI WI, T2WI, T2/SPIR （Fat-Saturation T2WI） and coronal B-FFE. MRI and MRCP appearances were compared with clinic,surgical findings and pathology. Results Plain MRI showed intrahepatic masses in 20（including multiple masses 4 cases） and hilar metastasis（including lymph node enlargement） in 12 of 43patients. MRI showed periductal-infiltrating type in 8 and mass-forming type in 3 of I 1 patients with hilar cholangiocarcinoma. The morpho- logical characteristics of the obstructive erads can be observed on MRCP ＂＇tapered-form＇＂ in 26 cases, ＂cut off-form＂ ira 13 cases, ＂bird mouth-form＂ in 4 cases. The dilated intrtlhepatic bile ducts appeared ＂tree branches-like＂ and ＂＇soft-canes-like＂. Conclusion Conventional MRI in combination with MRCP carl help lbr the diagnosis of the location and nature of malignant hilar biliary obstructive diseases and clinical treatment.