MRCP对胆系梗阻性疾病的诊断及鉴别诊断研究

目的 探讨胆系梗阻性疾病的MRCP表现及其临床诊断价值.方法 对2002年12月至2004年12月共342例胆系梗阻性疾病进行MRCP检查,所有病例经手术病理或其他影像学和临床资料所证实.使用GE signa MRI/echo speed超导型1.5TMR扫描机,常规行上腹部T1WI和T2WI轴位扫描,MRCP采用单次激发快速自旋回波序列进行冠状位扫描.结果 342例胆系梗阻性疾病的定位诊断正确率为100%,结合常规平扫及其他影像学检查定性诊断正确率可达到92.4%.良性病变（包括胆管结石、胆总管囊肿及胆管炎性狭窄）140例,占所有病例的41%,诊断正确率达95.7%.医源性肝外胆管狭窄21例,占6%,诊断正确率达95.2%.恶性病变（包括胆管癌、胰头癌及壶腹癌）181例,占53%,诊断正确率达89.5%.结论 MRCP作为一种无创性检查手段,结合磁共振平扫和其他临床资料可对良性梗阻性病变及壶腹以上部位的恶性胆道梗阻做出较准确的定性、定位诊断;但对于壶腹周围梗阻性病变的准确诊断有待于进一步研究和改进.

Diagnosis and differential diagnosis of biliary obstructive diseases with MRCP

Objective To investigate the MRCP findings of biliary obstructive diseases and their clinical significance.Methods Between December 2002 and December 2004 three hudred and forty-two patients with clinically and pathologically proved bilicary obstructive disease (BOD) underwent magnetic resonance cholangiopancreatography(MRCP).The procedure was performed on GE Signa 1.5 T magnet through single shot T2 weighted fast spin-echo sequence in the coronal plane.Axial T1-and T2 weighted sequences were first obtained.Results Among 342 patients with BOD,the accuracy of locating diagnosis was 100 %.When MRCP was combined with routine scan or other methodologies,the accuracy of qualitalive diagnosis was 92.4 %.The benign lesions which included calculus of biliary ducts,choledochocyst and inflammatory stenosis of biliary ducts wree found in 140 cases (41 %),and the diagnostic accuracy was 95.7 %,in addition,21 cases (6 %)were iatrogenic extrahepatic bile stenosis with 95.2 %of diagnostic accuracy.The malignant lesions which included bile duct carcinoma,carcinoma of pancreas head and ampulla carcinoma were found in 181 cases (53 %),the diagnostic accuracy was 89.5 %.Conclusion MRCP is a non invasive technique for visualization of the benign and malignant biliary obstructive diseases over ampulla but the correct diagnosis of obstructive diseases in peri-ampullar regions still need further investigating and improving.