磁共振胰胆管成像联合弥散加权成像诊断婴幼儿胆道闭锁应用研究  

Application of magnetic resonance cholangiopancreatography and diffusion-weighted imaging in the diagnosis of infants with biliary atresia

作　　者：何智 屈泽东 刘杰 牛猛 He Zhi;Qu Zedong;Liu Jie(Department of Radiology,Northwest Women and Children's Hospital,Xi'an 710061,Shaanxi Province,China)

机构地区：[1]西北妇女儿童医院医学影像中心,西安市710061 [2]兰州大学第一附属医院放射科

出　　处：《实用肝脏病杂志》2024年第4期631-634,共4页Journal of Practical Hepatology

基　　金：陕西省科技厅科研计划项目(编号:2021QJ-421)。

摘　　要：目的探讨使用磁共振胰胆管成像(MRCP)联合弥散加权成像(DWI)诊断婴幼儿胆道闭锁(BA)的价值。方法2019年10月~2022年10月我院诊治的先天性BA患儿40例,术前接受磁共振成像(MRI)、MRCP和DWI检查,分析不同检查方式的影像学表现,术中行胆道造影检查。结果40例BA患儿经3D-MRCP检查,显示肝外胆管未显影7例(17.5%),胆管细小24例(60.0%),轻度扩张8例(20.0%),胆总管囊肿1例(2.5%)。见肝内胆管稀疏或不显影34例(85.0%),显影6例(15.0%)。显示胆囊细小呈条索状31例(77.5%),胆囊正常9例(22.5%);DWI显示肝外胆管未显影15例(37.5%),胆管细小19例(47.5%),轻度扩张5例(12.5%),胆总管囊肿1例(2.5%)。见肝内胆管稀疏或不显影31例(77.5%),显影9例(22.5%)。显示胆囊细小29例(72.5%),正常11例(28.5%);T2加权成像显示肝内见三角形影31例(77.5%),DWI显示肝内呈高信号33例(82.5%),肝门区高信号为(0.8±0.2)cm;MRI检查显示肝脏右叶增大12例(30.0%);术中胆道造影显示胆总管、肝总管和肝内胆管不显影29例(72.5%),胆总管呈囊状扩张11例(28.5%);术中见肝门区纤维组织块36例(90.0%),平均直径为(1.2±0.5)cm,其中胆囊萎缩33例(82.5%),肝肿大22例(55.0%),合并肝硬化6例(15.0%);术中检查诊断Ⅰ型BA 1例(2.5%),Ⅲ型BA 39例(97.5%),未见Ⅱ型闭锁;MRI、MRCP联合DWI诊断BA正确率为90.5%,显著高于MRI联合3D-MRCP诊断的77.5%(P<0.05)。结论MRCP联合DWI检查诊断婴幼儿BA可全面、直观地显示胆道系统影像,具有较高的临床应用价值。Objective The purpose of this study was to investigate the diagnostic performance of magnetic resonance cholangiopancreatography(MRCP)and diffusion-weighted imaging(DWI)in infants with biliary atresia(BA).Methods 40 children with congenital BA were admitted to our hospital between October 2019 and October 2022,and all underwent MRI,MRCP and DWI scan before operation.The imaging manifestations were recorded,and the diagnostic performances of MRI,3D-MRCP and DWI were compared.Results Out of the 40 children with BA,the 3D-MRCP showed the extrahepatic bile duct undeveloped in 7 cases(17.5%),tiny bile ducts in 24 cases(60.0%),slightly dilated in 8 cases(20.0%)and choledochal cyst in 1 case(2.5%),the sparse intrahepatic bile ducts or not developed bile ducts in 34 cases(85.0%)and developed bile ducts in 6 cases(15.0%),the small gallbladder in 31 cases(77.5%)and normal gallbladder in 9 cases(22.5%);the DWI showed the undeveloped extrahepatic bile duct in 15 cases(37.5%),tiny ducts in 19 cases(47.5%),slightly dilated ducts in 5 cases(12.5%),the choledochal cyst in 1 case(2.5%),the sparse or not developed intrahepatic bile ducts in 31 cases(77.5%),the developed ducts in 9 cases(22.5%),the tiny gallbladders in 29 cases(72.5%)and normal gallbladders in 11 cases(28.5%);the T2-weighted imaging showed intrahepatic triangular shadows in 31 cases(77.5%),and the DWI showed high intrahepatic signals in 33 cases(82.5%),with the high signal intensity of(0.8±0.2)cm in hilar region;the MRI found the enlarged right lobes of liver in 12 cases(30.0%);the intraoperative cholangiography revealed the undeveloped common bile duct,common hepatic duct and intrahepatic bile duct in 29 cases(72.5%),and the cystic dilatation of common bile ducts in 11 cases(28.5%);during the operation,the fibrous mass in the hilar region was found in 36 cases(90.0%),with the average diameters of(1.2±0.5)cm,and we also found gallbladder atrophy in 33 cases(82.5%),the hepatomegaly in 22 cases(55.0%)and liver cirrhosis in 6 cases(15.0%);the diagnosis based on intr

关 键 词：胆道闭锁 磁共振胰胆管成像 弥散加权成像 胆道造影 婴幼儿 诊断 

分 类 号：R725.7[医药卫生—儿科]