低场强MRCP对恶性胆管梗阻的诊断及临床价值  

Diagnosis and clinical value of low field intensity MRCP in patients with malignant biliary duct obstruction

作　　者：贾天礼 林井副[2] 

机构地区：[1]大同煤矿集团第三职工医院,山西大同037017 [2]中国人民解放军海军总医院,北京100037

出　　处：《基层医学论坛》2008年第34期1117-1119,共3页The Medical Forum

摘　　要：目的评价低场强MRCP对胆管恶性梗阻性疾病的诊断价值。方法39例胆管梗阻恶性患者,常规T1WI、T2WI及脂肪抑制T2WI检查后,行MRCP检查,结合手术、病理结果、临床资料进行综合分析。结果39例患者MRCP检查均一次成功,胆管及胰管扩张显示满意,定位诊断准确率为100%,定性准确率为82%。3例MRCP仅肝内胆管扩张,肿块T2WI高信号;8例肝门区癌肿MRCP表现为肝门区不规则或类圆形信号缺损,肝内胆管扩张以肝门区为中心呈"枯枝"状或"蟹足"样扩张,肿块T2WI高信号。16例胆总管中段截断,胆管断端呈横形或"鸟嘴"样截断,近段胆管、肝内胆管扩张,肿块T2WI稍高信号5例;12例胆管末端截断或狭窄,胆管断端呈横形、"鸟嘴"样或"鼠尾"状截断,90%(10/12)伴"双管征",肿块T2WI稍高信号8例。结论MRCP能较好地显示胰胆管的解剖和病理变化,可为恶性胆胰肿瘤术前可切除性提供评价,对不可切除的癌肿行介入治疗提供参考。Objective To evaluate of Low Magnetic Filed MR Cholangiopnceatography （MRCP）in the diagnosis of malignant bile duct obstruction.Methods Thirty-nine cases were included in this study, MRCP were performed following T1WI, T2WI and fat-saturation T2WI in each case, Combined with surgical findings and pathological results,a comprehensive analysis was conducted.Results MRCP was succeeded with one procedure in all Thirty-nine case, and the bile duct was well displayed. The accuracy of MRCP in localizing and qualitative diagnosis was 100% and 82% respectively. Hyperintense signals on T2WI and intrahepatic bile duct dilation on MRCP can be observed in3 cases. In 8 cases, on MRCP hepatic portal carcinoma demonstrated irregular or oviform signal loss in hepatic portal area, and dilatation of the intrahepatic ducts presenting as＂withered tree branches＂or ＂crab＇s claws＂, Hyperintense signals on T2WI.In 16 cases, abrupt obstruction of middle segment of common bile duct on MRCP of which 5 cases had slight hyperintense signals on T2WI, the obstructed end displayed abrupt cut-off or＂beak-like＂appearance. Obstruction or stenosis of distal common bile and pancreatic duct dilation on MRCPcan be seen in 12 cases. the obstructed end displayed abrupt ＂cut-off ＂or ＂beak-like＂ or ＂mouse tail＂appearance with ＂double duct＂sign （10/12, 90% ）.and only 8 cases of which had slight hyperintense signals on T2WI.Conclnsion MRCP displayed the anatomy and pathological changes of the ducts, It could help make a preoperative assessment of the potential of resection and provide useful information for interventional therapy when the tumor was unresectable.

关 键 词：胆管梗阻 低磁场MRI 胰胆管造影术 

分 类 号：R735[医药卫生—肿瘤]