DWI与THRIVE多期动态增强序列联合诊断肝外胆管癌的价值  

The Value of DWI Combined with THRIVE Multi Phase Dynamic Contrast Enhanced Sequence in the Diagnosis of Extrahepatic Bile Duct Carcinoma

作　　者：曾德银[1] 何晓鹏[1] 赵冬梅[1] 唐光才[2] 

机构地区：[1]四川省泸州医学院附属医院放射科,646100 [2]泸州医学院

出　　处：《临床放射学杂志》2014年第2期213-216,共4页Journal of Clinical Radiology

摘　　要：目的探讨扩散加权成像(DWI)和T1高分辨力各向同性容积激发(THRIVE)多期动态增强序列联合诊断肝外胆管癌的价值。方法病理证实29例肝外胆管细胞癌,术前MRI常规序列、DWI及THRIVE多期动态增强扫描,第1次联合MRI常规序列、THRIVE动态增强图像诊断,第2次联合所有序列图像诊断,以病理结果为金标准比较2次诊断符合率;测胆管癌、增大淋巴结的表观扩散系数(ADC)值,并作均数比较t检验分析。结果手术病理证实29例肝外胆管癌,2例肝左管、2例肝右管受浸润,4例肝组织受侵,1例胆管瘤栓,淋巴结转移8枚、反应性增生14枚。联合DWI后提高了增大淋巴结的诊断率。胆管癌、淋巴结转移、淋巴结反应性增生的ADC值(单位:106mm2/s)分别为330.50±83.58、365.75±43.52、430.79±53.77。胆管癌、淋巴结转移分别与淋巴结反应性增生比较均有统计学差异(P﹤0.05),胆管癌与淋巴结转移无统计学差异(P﹥0.05)。结论 DWI对淋巴结增大敏感性高,ADC值可鉴别淋巴结转移与反应性增生;DWI与THRIVE多期动态增强联合运用诊断肝外胆管癌有较高价值。Objective To Explore the Value of DWI combined with THRIVE multi phase dynamic contrast enhanced sequence in the diagnosis of extrahepatic bile duct carcinoma. Methods 29 cases of extrahepatic bile duct cell carcinoma confirmed by pathology underwent MRI routine sequence, DWI and THRIVE multi phase dynamic contrast enhanced scan prior to surgery. The first diagnosis made by MRI routine sequence combined with THRIVE dynamic contrast enhanced im- ages, and the second diagnosis made by combining all the sequence images. The coincidence rate of the two diagnosis re- sults were compared according to pathological results as the gold standard. The ADC values of bile duct carcinoma and lymph node were measured. Results 29 cases of extrahepatic bile duct carcinoma were confirmed by surgery and patholo- gy . The lesions included left hepatic duct infiltration in 2 cases, right hepatic duct infiltration in 2 cases, hepatic tissue in- vasion in 4 cases, bile duct tumor thrombus in 1 case, lymph node metastasis in 8 and lymph node reactive hyperplasia in 14 cases. The diagnostic accuracy of enlarged lymph node has been increased after combining with DWI. The ADC value （Unit：mm2/106s） of bile duct carcinoma, lymph node metastasis and lymph node reactive hyperplasia were 330.50 ±83. 58,365.75 ±43.52,430.79 ±53.77respectively. There were statistical differences （ P 〈 0.05 ） of ADC values between bile duct carcinoma and lymph node reactive hyperplasia, between lymph node metastasis and lymph node reactive hyper- plasia, while there was no statistical difference （P 〉 0.05 ） of ADC value between bile duct carcinoma and lymph node me- tastasis. Conclusion DWI has high sensitivity to the enlargement of lymph nodes. The lymph node metastasis and reac- tive hyperplasia can be identified based on the ADC values. The diagnosis accuracy of extrahepatic bile duet carcinoma can be increase by combine DWI with THRIVE multi phase dynamic enhancement.

关 键 词：磁共振 扩散加权成像 胆管癌 

分 类 号：R445.2[医药卫生—影像医学与核医学]