MR不同脉冲序列成像诊断胆囊腺肌瘤病的价值  

MRI diagnosis of gallbladder adenomyomatosis: optimization of various pulse sequences

作　　者：靳二虎[1] 马大庆[1] 磯田裕義 河相吉 植村芳子 朝倉環 赤井幹夫 池田耕士 谷川昇 梁宇婷[1] 澤田敏 

机构地区：[1]首都医科大学附属北京友谊医院放射科,100050 [2]関西医科大学附属病院放射線科 [3]関西医科大学附属病院外科病理室

出　　处：《中华放射学杂志》2005年第4期418-422,共5页Chinese Journal of Radiology

摘　　要：目的分析35例胆囊腺肌瘤病患者的MRI表现,比较不同脉冲序列显示Rokitansky Aschoff窦(RAS)能力的差异。方法经组织学证实诊断的35例胆囊腺肌瘤病患者(男19例,女16例,年龄32～72岁,平均52岁)均进行了MR常规T1WI、常规T2WI、3mm薄层T2WI及MR胰胆管成像(MRCP)。2名高年资放射科医生共同分析MRI,观察胆囊壁增厚情况及RAS信号表现,并与病理所见对照。根据5级评分标准,对RAS可信度达到4和5级的MRI脉冲序列进行统计学分析,比较不同脉冲序列显示RAS能力的差异。结果35例患者的胆囊壁均明显增厚,厚度范围5～12mm,平均7mm。其中包括局限型胆囊腺肌瘤病16例,节段型12例,弥漫型7例。RAS表现为病变胆囊壁内数量不等、大小不一的点状异常信号,其大小2～7mm,平均4mm。在T2WI和MRCP上,RAS呈点状高信号;在T1WI,RAS可呈低、高或等信号。RAS显示率在3mm薄层T2WI、常规T2WI、MRCP、T1WI依次为100%、60%、60%、26%(χ2=40.88,P<0.01)。结论3mm薄层T2WI显示RAS效果最佳。Objective To compare the detectability of Rokitansky-Aschoff sinuses (RAS) in patients with pathologically confirmed gallbladder adenomyomatosis in varied MR pulse sequences. Methods MR imaging of 35 patients (19 males and 16 females, the age ranged from 32 to 72 years, mean 52 years) with gallbladder adenomyomatosis was studied on the 1.5 T and 0.5 T MR systems. For each patient, 4 pulse sequences were performed including axial T_1WI and T_2WI with 7 mm slice thickness, axial 3 mm thin-slice T_2WI, and MRCP. MRCP was produced by breath-hold thick-slab single-shot fast spin echo (SSFSE) method and 3-dimentional fat-suppressed fast spin echo with MIP reconstruction technique. Two radiologists evaluated the MR images and scored the RAS according to a 5-point confidence scale. RAS graded as 4 or 5 was used for further statistical analysis. Finally, the MR findings were correlated with surgical specimen and histopathological results. Results In this group, gallbladder wall thickening was showed on MRI in all patients and the thickness was from 5 to 12 mm (mean 7 mm). Among them, 16 fundal type, 12 segmental type, and 7 diffuse type of gallbladder adenomyomatosis were identified. The RAS was seen in the diseased gallbladder wall and its size ranged from 2 to 7 mm (mean 4 mm). On MR imaging, RAS appeared as hyperintensity on T_2WI and MRCP, hypo-, iso- or hyperintensity on T_1WI depending on the extent of bile concentration. Thin-slice T_2WI detected RAS in 35 cases (100%), both conventional T_2WI and MPCP in 21 (60%), and T_1WI in 9 (26%). 3 mm thin-slice T_2WI was superior to T_1WI, T_2WI, and MPCP in showing RAS (χ 2= 40.88, P<0.01). Conclusion 3 mm thin-slice T_2WI was optimal in showing RAS.

关 键 词：胆囊腺肌瘤病 脉冲序列 成像诊断 MR胰胆管成像 T2WI 价值 T1WI RAS MRCP MRI表现 放射科医生 胆囊壁增厚 统计学分析 信号表现 评分标准 异常信号 患者 组织学 平均 薄层 可信度 局限型 节段型 弥漫型 高信号 显示率 能力 

分 类 号：R735.8[医药卫生—肿瘤]