恶性梗阻性黄疸的MRI诊断及评价(附30例分析)

目的:评价磁共振成像对恶性梗阻性黄疸的诊断价值。方法:30例临床怀疑恶性梗阻性黄疸的患者术前行MRI检查。扫描序列包括快速自旋回波(TSE)T1WI、T2WI、压脂后增强扫描、TSE-MRCP和真稳态快速进动成像(TrueFISP)。所得结果与手术及病理所见进行对照。结果:各MRI序列均能准确判断胆管内径、梗阻的部位及程度,其中以MRCP最为快捷方便。术前结合各序列总诊断符合率为86.7%(26/30)。胰头癌在T1WI增强扫描及T2WI平扫上的肿块显示率(均为83.3%)及受侵血管显示率(均为81.3%)高于其它序列。胆管肿瘤在各序列上均能显示,但TrueFISP序列、T1WI增强扫描能较好地显示肿块累及范围。结论:MRCP对评价胆管内径、梗阻的部位及程度优于其它序列,T1WI增强扫描及T2WI平扫能较好显示胰头癌的大小及累及范围,TrueFISP序列和T1WI增强扫描能较好显示胆管肿瘤的大小及累及范围。

The Role of MRI in Diagnosis and Evaluation of Malignant Obstructive Jaundice(Analysis of 30 Cases)

Objective:To evaluate the role of several MR sequences in diagnosing and assessing malignant obstructive jaundice.Methods:30 patients with suspected malignant obstructive jaundice were performed MR examination (Siemens 1.5T Sonata).Frequency sequences included TSE-T_1WI,TSE-T_2WI,TSE SPIR-T_1WI with Gadolinium administration,TSE-MRCP,True FISP.All the findings were compared with the results of operation and pathology.Results:MRCP is the best way to evaluate the site and degree of obstruction.The accuracy with all the sequences in diagnosis of obstructive jaundice is 86.7%.Both ratio of the T_2WI and T_1WI (with contrast) in displaying the carcinoma of head of pancreas were 83.3%, and that of displaying invaded vessels were 81.3%,which were higer than other sequences.Cholangiocarcinoma was more clear on True FISP and T_1WI with contrast enhancement.Conclusion:MRCP is best in evaluating the locus and degree of obstruction.T_2WI and T_1WI with contrast enhancement are good at evaluating the carcinoma of head of pancreas.True FISP and T_1WI with contrast enhancement are good at evaluating cholangiocarcinoma.