胆管癌磁共振成像诊断.docVIP

胆管癌磁共振成像诊断 　［摘 要］ 目的：探讨磁共振成像(MRI)对胆管癌的诊断价值。方法：回顾性分析18例经手术、病理证实的胆管癌MRI检查资料，研究其MRI表现。结果：18例胆管癌表现为胆管行程区肿块，胆管中断、扩张，肝内胆管“软藤”征。肝内胆管癌3例，肝门部胆管癌10例，肝外胆管癌5例。肿块T1WI呈低信号，T2WI呈高信号，信号不均匀，动态增强扫描有延迟强化，MRCP检查所有病例均有不同程度胆管扩张或中断。结论：胆管癌的MRI和MRCP表现具有特征性，MRI及MRCP对胆管癌具有较高的诊断价值。　　［关键词］ 胆管癌；磁共振成像；临床诊断 　　MRI Diagnosis of Cancer of Biliary Duct 　　Abstract Objective To study the MRI diagnostic value on cancerof biliary duct．Methods The MRI examination data of 18 patients with cancer of biliary duct proved by operation and pathology were analyed retrospectively，and the manifestations of MRI were reviewed．Results Mass along the biliary duct can be seen in 18 patients.The bilary duct interruption and cholangiectasis also can be seen．The intrahepatic duct showed as soft rattan．3 patients were ntrahepatic biliary duct cancer，10 patients were hepaticportal biliary duct cancer，and 5 patients were extrahepaticbiliary duct cancer．The mass showed as low signal on T1WI and high signal on T2WI．The signal intensity was nonhomogeneous．GdDTPA dynamic enhancement scan，there was delayted enhancement in tumor．All patients had cholangiectasis and biliary duct obstrtruction on MRCP．Conclusion MRCP and MRI manifestations of biliary duct cancer had features．MRCP and MRI examination had high clinic value in diagnosing biliary duct cancer． 　　Key words:Cancer of biliary duct；Magnetic resonance image；Clinic diagnose 　　回顾性分析我院经手术、病理确诊的18例胆管癌病例，分析其磁共振成像(MRI)表现，以提高对本病的认识和诊断符合率。 　　1 资料和方法 　　1.1 一般资料 18例胆管癌患者，男13例，女5例，年龄60岁以上11例，占60％，35岁～60岁间7例，所有患者均有完整的临床、手术、病理资料。临床主要厌油、纳差、黄疸。 　　1.2 方法 所有病历均在1.5 T超导MRI扫描系统检查中，作常规MRI平扫、MRCP、动态增强MRI扫描。SE序列扫描获得T1WI(TR=198 ms，TE=4.76，FOV 350)及T2WI(TR=1 300 ms，TE=70，FOV 360)，MRCP成像参数TR=1 100 ms，TE=248，FOV=350)。层厚4 mm，间隔0.8 mm。GDDTPA动态增强扫描剂量0.2 mmol/kg，层厚3 mm，间隔1 mm，分动脉期、门静脉期、延迟期三期扫描。 　　2 结果 　　18例均表现为胆管行程区包块，T1WI比肝实质的信号低，T2WI较高信号，3例位于肝内胆管与肝癌不易区别，10例位于肝门胆管，5例胆总管中下段，最大病灶约为60 mm×78 mm大小，14例病灶内部信号不均，见线状、细条状长T1短T2信号影，边缘清。胆总管扩张3例，左、右肝内胆管不能汇合10例，肝内胆管中、重度扩张12例，轻度扩张6例，肝总管扩张8例。MRCP显示肝内胆管扩张10例，伴有软组织包块。胆管