低张饮水后MRCP对十二指肠憩室分型及与胆道梗阻相关性的价值  

The value of the classification of duodenal diverticulum and it’s correlation with biliary obstruction by hypotonic MRCP after oral water

作　　者：文红华 陈刚文 李先泰 唐春容 易成[2] 刘易 WEN Honghua;CHEN Gangwen;LI Xiantai;TANG Chunrong;YI Cheng;LIU Yi(Department of MRI,The First People's Hospital of Jintang,Chengdu 610400,P.R.China;Dipartment of Hepatobiliary Surgery,The First People's Hospital of Jintang,Chengdu 610400,P.R.China)

机构地区：[1]四川省成都市金堂县第一人民医院核磁共振室,四川成都610400 [2]四川省成都市金堂县第一人民医院肝胆外科,四川成都610400

出　　处：《医学影像学杂志》2021年第3期463-467,共5页Journal of Medical Imaging

摘　　要：目的探讨低张饮水后MRCP对十二指肠憩室的检出及分型的临床价值,评价憩室的发生部位与胆道梗阻程度的相关性。方法选取经上消化道钡餐及胃十二指肠镜确诊的78例DD患者的MRI资料,所有患者于常规上腹MRI平扫+MRCP(简称常规MRCP)后中止检查,低张饮水500~800 ml,20 min后再行横断T_(2)WI高分辨扫描+MRCP(简称低张力MRCP)检查,原始数据传送至ADW4.6工作站后处理,双盲法判定憩室数目、发生的部位及分型,评估胆道梗阻程度,分析憩室部位与胆道梗阻的相关性。结果78例DD患者中,常规MRCP发现憩室82个:憩室内型13个、边缘型40个、周围型23个、远离型6个,低张力MRCP检出憩室80个:憩室内型4个、边缘型29个、周围型41个、远离型6个。两种影像学检查对DD的检出差异无统计学意义(χ^(2)=0.01,P>0.05)。低张力MRCP对憩室内型、周围型憩室的检出优于常规MRCP(χ^(2)=4.13,P<0.05)、(χ^(2)=3.97,P<0.05)。DD伴发胆道梗阻者56例,发生率为71.79%。DD发生的部位与胆道梗阻程度有相关性,其中憩室内型并发的胆道梗阻程度与周围型、远离型憩室并发的胆道梗阻程度之间的差异具有统计学意义(t=4.32,P<0.05)、(t=5.84,P<0.01)。结论十二指肠憩室是诱发胆道梗阻的重要原因,憩室的发生部位与胆道梗阻程度具有相关性,低张力MRCP有助于憩室的检出及准确分型。Objective To investigate the clinical value of hypotonic magnetic resonance cholangiopancreatography(MRCP)in the detection and classification of duodenal diverticulum(DD),and to evaluate the correlation between the location of DD and the degree of biliary obstruction.Methods We retrospectively analyzed the MR data of 78 DD patients who were diagnosed by upper digestive tract barium meal examination and the gastroduodenal examination.All patients suspended the examination after the normal upper abdominal MRI with MRCP(normal MRCP),while,those patients,who drunk 500~800 ml of hypotonic water,were re-performed cross-sectional T_(2)WI high-resolution with MRCP(Hypotonic MRCP)after 20 minutes.The original data were transmitted to the ADW4.6 workstation for dispose.Using double-blind method,we determined the number,location and type of DD,assessed the extent of biliary obstruction,and analyzed the correlation between biliary obstruction and the location of DD.Results In 78 DD patients,the normal MRCP found 82 DD,including 13 of intra-diverticulum type,40 of edge-diverticulum type,23 of around-diverticulum type,and 6 of away-diverticulum type;hypotonic MRCP found 80 DD including 4 of intra-diverticulum type,29 of edge-diverticulum type,41 of around-diverticulum type,and 6 of away-diverticulum type.There was no statistically significant in the detection of DD between the two examination methods(χ^(2)=0.01,P>0.05).For the intra-diverticulum type and the around-diverticulum type,the detection of hypotonic MRCP was significantly higher than that of normal MRCP(χ^(2)=4.13,P<0.05),(χ^(2)=3.97,P<0.05).Among the 78 DD patients,there were 56 cases with biliary obstruction.The incidence rate was 71.79%.There were some correlation between the location of DD and the degree of biliary obstruction.The degree of biliary obstruction caused by intra-diverticulum type was more serious than that caused by around-diverticulum type and away-diverticulum type,the difference was statistically significant(t=4.32,P<0.05),(t=5.84,P<0.01).Conc

关 键 词：十二指肠憩室 胆道梗阻 胆胰管造影术 磁共振成像 

分 类 号：R574.4[医药卫生—消化系统] R445.2[医药卫生—内科学]