MRCP对十二指肠憩室诊断价值.docVIP

MRCP对十二指肠憩室诊断价值 　 作者：刘奉立，于本霞，苏续清，岳凤斌，邹平 【摘要】 目的 探讨磁共振胰胆管成像（MRCP）对十二指肠憩室的诊断价值。方法 2004年3月～2005年2月，使用GE Signa 1.5T MR扫描仪，对因上腹痛或伴有黄疸的患者行MRCP检查，采用薄层（3mm层厚，零间隔）及厚层（50mm层厚）成像，在观察胰胆管的同时，着重观察十二指肠及其周围结构，以期发现憩室或其他病变。结果 共发现6例十二指肠憩室，男1例，女5例；年龄53～74岁，平均65岁。所有憩室均位于十二指肠降段与胰头之间。6例中2例显示胆总管下段受压绕行，伴有胆总管及胰管的不同程度扩张，2例合并胆总管下端结石，1例合并胆总管下段炎性狭窄，另1例较大憩室因压迫胰头区而致胰胆管扩张。所有病例均经十二指肠镜检查证实。在MRCP图像上，十二指肠憩室表现为一端连于十二指肠，另一端为游离的盲袋样结构，其形态及信号均类似于十二指肠。3例憩室内可见散在气泡影或气—液平面，以横轴位T2WI显示较佳。1例较大憩室呈盘曲状，轴位像上呈多囊样改变，增强扫描囊壁与十二指肠壁呈同等强化，囊内容物无强化。结论 MRCP对发现十二指肠憩室较为敏感，也非常准确，并能显示某些并发症；缺点是难以显示黏膜溃疡及一般炎症；但由于其为无创性检查，简便易行，患者无痛苦，故仍不失为一种较好的检查方法。 【关键词】 胰胆管成像；磁共振；十二指肠憩室；影像诊断 【Abstract】 Objective To evaluate the value of magnetic resonance cholangiopancreatography (MRCP) in detecting duodenal diverticulum.Methods From March of 2004 to Feberuary of 2005，with GE Signa 1.5 tesla MR equipment，MRCP was performed on a series of patients with abdominal pain or together with jaundice.The MRCP was performed in both thin slice (3mm thickness with no gap) and thick slice (50mm thickness).In film reading，particular attention was paid to the observation of duodenum and the surrounded structures，in addition to the observation of cholangiopancreatic ducts，so as to find if any diverticulum or other abnormalities exist.Results 6 cases of duodenal diverticulum were found.Among them，one was male and 5 were female.The age was ranged from 53 to 74 years，with an average of 65.All of the diverticula were situated between the descending section of duodenum and the pancreatic head.2 cases were complicated by choledocholith； one with inflammatory stenosis of the choledocho duct.In another case，the diverticulum was so large that the pancreatic head was heavily pressed and the cholangiopancreatic ducts dilated.All of the diverticula were confirmed by endoscopic examinations.On MRCP pictures，the duodenal diverticulum presented as a “blind duct”，with one end connected to the diverticulum，and the other end being free.The shape and signal intensity were similar t