排泌性MR胆管成像术前评估活体肝移植供体胆管解剖的价值  

The Value of Preoperative Evaluation of Biliary Anatomy of Donor in Living Donor Liver Transplantation by Secretory MR Cholangiography

作　　者：钟燕[1] 王海屹[1] 潘晶晶[1] 孙希杰[1] 蔡幼铨[1] 叶慧义[1] 

机构地区：[1]解放军总医院放射科,北京100853

出　　处：《当代医学》2009年第26期54-56,共3页Contemporary Medicine

摘　　要：目的探讨排泌性MR胆管成像(Secretory magnetic resonance cholangiography,SMRC)术前评估活体肝移植供体胆管解剖结构的诊断价值。方法回顾性分析活体肝移植术的64例供体的术前SMRC、磁共振胆胰管成像(Magnetic resonance cholangiopancreatography,MRCP)原始及最大密度投影(Maximum intensity projection,MIP)重建图像,与术中所见胆管进行对照分析。结果经术中所见证实64例供体中有58例(90.6%)胆管解剖正常,6例(9.4%)变异。术前SMRC诊断准确胆管解剖62例,准确率为96.9%,包括58例正常胆管解剖结构、4例变异胆管;SMRC检出变异胆管的灵敏度和特异度分别为66.7%、100%。术前MRCP诊断准确60例,准确率为93.8%,包括58例正常胆管解剖结构、2例变异,其检出变异胆管的灵敏度33.3%、特异度100%。SMRC结合MRCP准确诊断胆管解剖63例,准确率为98.4%,其中58例正常胆管解剖、5例变异;其检出变异胆管的灵敏度和特异度分别为83.3%、100%。结论联合应用SMRC和MRCP的灵敏度、准确率均高于SMRC或MRCP,但特异度与SMRC或MRCP无差异。SMRC能为活体肝移植术前手术方案的制定提供准确信息。Objective To discuss the value of preoperative evaluation of biliary anatomy of donor in living donor liver transplantation by secretory magnetic resonance cholangiography （SMRC）. Methods To retrospectively analyze the sixty-four living donor＇s original primary and maximum intensity projection （MIP） reconstruction images of SMRC and magnetic resonance cholangiopancreatography （MRCP）. All patients underwent partial hepatectomy. The imaging findings were compared with intraoperative results. Results In the 64 patients who underwent partial hepatectomy, 58 （90.6%） had normal biliary anatomy and 6 （9.4%） had biliary anatomic variants conformed by intraoperative findings. SMRC cholangiography showed a correct diagnosis in 62（96.9%） of the 64 patients, including 58 with normal biliary anatomy and 4 with biliary anatomy variants. SMRC had a sensitivity in differentiating normal from variant anatomy of 66.7%, specificity of 100%. MRCP showed a correct diagnosis in 60 （93.8%） of the 64 patients, including 58 with normal biliary anatomy and 2 with biliary anatomy variants. The sensitivity and specificity of MRCP in differentiating normal from variant anatomy was 33.3%,100%, respectively. SMRC combined with MRCP images showed a correct diagnosis in 63（98.4%） of the 64 patients, including 58 with normal biliary anatomy and 5 with biliary anatomy variants. And SMRC combined with MRCP had a sensitivity in differentiating normal from variant anatomy of 83.3%, specificity of 100%, respectively. Gonclusion The accuracy and sensitivity of the combination of SMRC and MRCP was better than SMRC or MRCP alonef-but no difference in the specificity between them. Thus, SMRC can offer value information for preoperative scheme of living transplantation.

关 键 词：排泌性MR胆管成像 磁共振胆胰管成像 胆管解剖 

分 类 号：R657.3[医药卫生—外科学] R445.2[医药卫生—临床医学]