钆塞酸二钠短T_2效应对胆道结构和结石显示的影响  

The T_2-Shortening Effect of Gadoxetate on the Visualization of Biliary Structure and Calculi

作　　者：杨凤娇[1] 张艳[1] 高红[1] 钟晶[1] 叶佳[1] 刘晓亮[1] 吴建伟[1] 

机构地区：[1]解放军第八一医院影像科,南京210002

出　　处：《临床放射学杂志》2017年第8期1134-1139,共6页Journal of Clinical Radiology

摘　　要：目的探讨高浓度钆塞酸二钠短T_2效应对T_2WI和磁共振胰胆管造影(MRCP)显示胆道系统解剖结构以及结石的影响。方法 66例肝硬化患者,Child-Pugh(CP)分级A级33例,B级24例,C级9例,行MRI钆塞酸二钠增强前及肝胆期10、15和20 min轴位SSFSE T_2WI和MRCP检查,记录对比剂在肝管、胆总管以及胆囊在T_2WI、MRCP上出现时间以及表现,分析其对胆道结构和病变显示影响。结果对比剂引起T_2WI上胆管信号降低(n=62),胆汁和对比剂分层(n=21),形成点状"充盈缺损"(n=6),在较宽大的胆管内对比剂形成浮云状低信号(n=2)。低信号的对比剂沿胆囊内侧壁充盈,在胆囊底部似充盈缺损(n=35),浮云状低信号(n=18),线样低信号沿胆囊长轴直达胆囊底部(n=1)。在T_2WI上肝胆期肝外胆道各部分显影程度和时间与CP分级相关(肝管延迟10 min r=-0.393,P=0.001;胆总管延迟10 min r=-0.416,P=0.001,延迟15 min r=-0.485,P<0.001;胆囊延迟10 min r=-0.365,P=0.004,15 min r=-0.329,P<0.001,延迟20 min r=-0.483,P=0.011),在MRCP上胆管显影也与CP分级相关(延迟10 min r=-0.555,P<0.001,20 min r=-0.372,P=0.002)。3例胆囊结石和1例肾盂结石与对比剂难以区分。结论钆塞酸二钠短T_2效应影响胆道解剖结构在T_2WI和MRCP上显示,而且与肝硬化程度相关,与胆道结石难以区分,建议这些序列安排在增强前进行。Objective To discuss the T2-shortening effect of Gd-EOB-DTPA on the visualization of biliary structure and calculi on T2-weighted images and MRCP. Methods The SSFSE T2-weighted imaging and MRCP were performed at precontrast and 10,15 and 20 minutes of hepatobiliary phase in 66 cirrhotic patients（ Child-Pugh A = 33,Child-Pugh B = 24 and Child-Pugh C = 9）. The time point of presence of Gd-EOB-DTPA within the bile duct and gallbladder and their manifestations on these images were recorded; their effect on the visualization of biliary structure and lesions were analysed.Results The T2-shortening effect of Gd-EOB-DTPA included signal intensity reduction in bile duct（ n = 62）,layering bile and contrast（ n = 21）,filling defects（ n = 6） and floating clouds（ n = 2）. In gallbladder,the concentrated contrast adhehered to the medial wall presented as thickened wall and filling defects in the fundus（ n = 35）,floating clouds（ n = 18）,a jet of concentrated contrast across gallbladder lumen（ n = 1）. On T2 WI,the degree and time point of opacification in the bile duct at hepatobiliary phase were correlated with Child-Pugh score（ hepatic duct delayed-10 min,r =-0. 393,P = 0. 001,common bile duct delayed-10 min,r =-0. 365,P = 0. 004,15 min,r =-0. 485,P〈0. 001,gallbadder delayed-10 min,r =-0. 365,P = 0. 004,15 min,r =-0. 329,P〈0. 001,20 min,r =-0. 483,P = 0. 011）,the opacification of bile duct on MRCP was also correlated with Child-Pugh score（ delayed 10 min,r =-0. 555,P〈0. 001,20 min,r =-0. 372,P =0. 002）. The artifact due to the concentrated contrast agent mimicked the stones in 3 cases with gallbladder stone and 1 case with kidney pelvis stone. Conclusion The shortening effect of Gd-EOB-DTPA affected the visualization of biliary structure which was correlated with the Child-Pugh scoring. It was difficult to distinguish contrast agent from biliary stone. We suggest that these sequences should be done before administration of Gd-EOB-DTPA.

关 键 词：钆塞酸二钠 磁共振成像 磁共振胰胆管成像 T2加权成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R575.62[医药卫生—诊断学]