恶性胆管梗阻性病变MRI及MRCP表现.docVIP

恶性胆管梗阻性病变MRI及MRCP表现 　 作者：姚立新， 钱万科， 莫本成, 李晓霞, 李华菊 　[摘要] 目的：探讨磁共振MRI及磁共振胰胆管成像MRCP在诊断肝内外恶性胆管阻塞性病变中的价值。方法：收集15例经手术病理和临床治疗证实的胆管恶性肿瘤病例，回顾性分析其影像学表现及与临床病理的关系。MRI检查采用T1WI和T2WI常规序列，所有病例均做MRCP扫描。结果：15例患者MRI均表现为肝内外胆管不同程度阻塞性扩张。阻塞性病变中，胆管腺癌9例，肝细胞癌4例，转移瘤2例。阻塞部位在肝门部7例，胰腺部2例，壶腹部及十二指肠乳头部6例。所有病例均经临床病理证实。结论：MRI与MRCP结合能显示胆管阻塞性扩张及阻塞部位，有较高的诊断价值。壶腹部胆管癌的直接肿块征像较少，以间接阻塞征像为主要诊断依据。 　　[关键词] 胆道阻塞;胆管癌;磁共振成像;磁共振胰胆管成像 　　Abstract: Objective To investigate the value of Magnetic Resonance（MR） imaging findings and MRCP in differential diagnosis of malignant biliary obstruction.Methods MR findings of 15 cases of carcinoma of biliary ducts confirmed surgically and pathologically were analysed retrospectively,MR Cholangio-pancreatography（MRCP） were performed in all 15 patients.Results Seven cases were intrahepatic cholangiocarcinoma.Tumor was isointensity or mild hypointensity on T1WI and mild hyperintensity on T2WI with irregular margin;two cases were blocked in the midportion of the bile ducts and 6 cases were located in lower portion with no evident mass seen on all T1WI and T2WI, MRI and MRCP could clearly show the blocked and stenotic location. All patients showed dilation in all bile ducts . One case of dilation of extrahepatic bile ducts was caused by pancreatic head carcinoma and 2 case were metastasis of the tumor of stomach and liver. MRCP demonstrated typical “double duct sign” and abrupt interruption at periampullary adenocarcinoma in 6 cases.Conclusion MRI combined with MRCP can increase the sensitivity of diagnosis in malignant biliary obstruction,the direct sign of tumor is less seen than indirect sign when the lesion is located in distal segment of dilated common bile duct.MRI and MRCP could improve diagnosis of the tumor location. 　　Key words: Biliary obstruction; Cholangiocarcinoma; MRI; MRCP 　　胆管MRI与MRCP即胆管磁共振平扫与磁共振胰胆管成像技术配合应用，因图像质量高,不用造影剂,无相关并发症,无痛苦, 其图像质量及诊断价值均较高，在胆胰系疾病诊断中应用越来越广泛。本文回顾性分析以往的诊断病例，对MRI与MRCP结合在肝内外胆管恶性阻塞性病变中的诊断价值进行评估，并对其影像特征进行分析。 　　1 材料与方法 　　我院从2002年4月-2005年3月期间共诊断肝外胆管恶性