增强MR胆道造影在非重度胆道梗阻中的临床应用初探  

Contrast-Enhanced Magnetic Resonance Cholangiography in Biliary Tract Obstruction： Primary Experiences and Findings

作　　者：廖承德[1] 梁碧玲[1] 钟镜联[1] 叶瑞心[1] 班晓华[1] 

机构地区：[1]中山大学附属第二医院放射科,广东广州510120

出　　处：《实用放射学杂志》2010年第6期843-846,共4页Journal of Practical Radiology

摘　　要：目的 本研究使用静脉注射钆贝葡胺 （gadobenate dimeglumine,Gd-BOPTA）增强后延迟MR扫描,用于显示肝内外胆道结构,探讨其在非重度胆道梗阻情况下对胆道的显示能力.方法 12例怀疑胆道梗阻患者,肝功能均为正常或肝功能代偿期,行常规肝脏MR扫描和胆管成像（MRC）,再经肘静脉注射Gd-BOPTA并延迟至1.5～2 h后采用THRIVE扫描序列行增强MR胆道造影（CE-MRC）检查.由2名影像诊断医师对比分析MRC及CE-MRC影像,使用χ2检验比较两者对胆管显示的差异,同时分析胆道梗阻或狭窄特点及胆管扩张程度与病变性质的关系.结果 12例受检者中共96个胆管节段用于评价,CE-MRC可显示其中的82个（85.4%）,显示率高于T2-MRC的61个（63.5%）（χ2= 12.08, P=0.00） CE-MRC未显示的多为梗阻远端未充盈造影剂的肝内胆管,T2-MRC未显示的为结石梗阻的汇管区及肝内未扩张的3级胆管.12例中7例异常（58.3%）,其中2例为胆总管结石、3例为肝内胆管结石、2例为肝内病变胆管外压性改变.结论 CE-MRC较MRC具有更高的肝内胆管显示率,但后者检查时间较长且对肝脏功能的依赖性较强.Objective To investigate the bile ducts visualization capacity of the contrast-enhanced magnetic resonance cholangiography （CE- MRC） performed with gadobenate dimeglumine （ Gd- BOPTA） in patients with non- severe biliary tract obstruction. Methods Twelve patients who suspected of biliary tract obstruction with normal or compensated liver function were included in this study. MR imaging of the liver and T1 weighted MR cholangiography （MRC） were performed in all patients,after that, CE- MRC were performed using the THRIVE exam protocol acquired 1. 5 to 2 hour after intravenous administration of gadobenate dimeglumine. The images of CE- MRC and MRC were readed by 2 radiologists indenpendently and compared in showing bile tract by both CE-MRC and MRC using χ2 statistic test. The causes and features of the bile tract obstruction were analysed. Results 96 biliary segments in 12 patients were evaluated, the integral indicated the superior visualization of biliary segments with CE-MRC （82/ 96 segments, 85.4%） compared with T2-MRC （61/96 segments, 63.5%）（χ2=12.08, P-0.00）. The biliary segments non- visualized at CE- MRC were the distant intra- hepatic ducts of obstruction which were non- filling of contrast medium. The hepatic confluence with bile duct calculi and un-dilated 3rd intra hepatic ducts could not be observed by T2- MRC. 7 patients with biliary duct obstruction were caused by common bile duct stone （2/7）, intra hepatic duct stone （3/7） and hepatic duct compression （ 2/7 ） caused by hepatic mass. Conclusion The superior visualization of biliary segments is revealed by CE-MRC compared with T2 - MRC,but CE-MRC lasts longer time consume and liver function dependency.

关 键 词：胆管 磁共振胆管成像 胆道梗阻 

分 类 号：R575.7[医药卫生—消化系统] R445.2[医药卫生—内科学]