MRI诊断十二指肠乳头旁憩室的应用分析

目的：探讨MRI不同检查方法对十二指肠乳头旁憩室（periampullary diverticulum,PAD）的诊断价值。方法：应用MRI多序列检查方法诊断PAD23例,并进行分析。结果：T1WI显示为囊状低信号影,与十二指肠相通者1例,其余22例表现为不均匀略低及高低混杂信号,均未明确诊断;横断位压脂T2WI显示含气液平面囊性病灶15例;冠状位FIESTA序列表现为混杂高信号或高信号影15例;呼吸触发3DMRCP表现为高或混杂高信号影16例;冠状位屏气3D-CELAVA动态增强扫描均清晰显示。其中合并胆系结石13例,胆系炎症及感染13例,胰腺炎3例,胆胰管扩张3例,十二指肠炎症3例。结论：MRI能多序列、多方位、直观、无创的清晰显示PAD的部位、大小、范围及与邻近结构的关系,同时显示胆胰疾病形态学改变。故MRI多序列检查非常必要,是PAD诊断及鉴别诊断的重要方法。

Analysis of Different MRI Methods in Diagnosis of Periampuilary Diverticulum

Objective： To assess the value of different MRI methods in diagnosis of periampullary diverticulum. Methods： Twenty-three patients with the periampullary diverticulum, who were examed by different MRI methods, were analysed from clinical and imaging aspects. Results： Only one case was found with cystic low signal intensity in T~WI and communication with the duodenum. The rest of them displayed uneven and nonsymmetrical low or high singnals and were diagnosed indefinitely. Fifteen cases displayed cystic lesions with gas-liquid plain in the axial breath holding, thin slice, fat saturation T2WI. Fifteen cases displayed high signal and asymmetry in the coronal FIESTA serie. Sixteen cases displayed high signal and asymmetry in respiration trigger 3D MRCP serie. All the cases displayed clearly in the coronal dynamic contrast enhancement LAVA serie. There were 13 cases accompanied with cholelithiasis, 13 cases with inflammation and infection of bile duct, 3 cases with pancreatitis, 3 cases with dilatation of bile duct and pancreas duct, 3 cases with inflammation of duodenum. Conclusion： MRI scan can not only demonstrate clearly the location, size, range of periampullary diverticulum and its relationship with adjacent structures, but also display the morphologic changes of pancreas and bile duct. There fore the multi-series MRI examination is very important in diagnosis and differential diagnosis of PAD.