MRI平扫、增强及MRCP在肝门胆管癌中的诊断价值.docVIP

MRI平扫、增强及MRCP在肝门胆管癌中的诊断价值 ====================================================================== 【摘要】? 目的 探讨MRI平扫、增强及磁共振胰胆管成像(MRCP)在肝门部胆管癌诊断中的价值。方法 收集经手术病理证实的肝门部胆管癌病例13例，回顾分析其影像学表现，MRI检查采用T2加权(T2WI)和T1加权(T1WI)序列平扫、3DT1加权加脂肪抑制(T1WIFS)动态增强扫描，所有病例均做MRCP。结果 13例肝门部胆管癌均可见肝门包块，肝内胆管扩张，动态增强扫描显示12例包块呈逐渐强化。1例动脉期显示强化。MRCP定位诊断率100%。按Bismuth分型，Ⅱ型6例，Ⅲa型2例，Ⅲb型3例，Ⅳ型2例。病理证实高分化腺癌7例，中分化腺癌4例，低分化腺癌2例。结论 MRI平扫及动态增强扫描并与MRCP结合对肝门部胆管癌有较高的诊断价值。? 【关键词】? 胆管肿瘤 磁共振成像 胰胆管造影术 磁共振 　　［ABSTRACT］ Objective To assess the diagnostic value of MRI and MRCP in hilar cholangiocarcinoma. Methods The data of MRI, 3D DCE and MRCP in 13 cases of hilar cholangiocarcinoma proved surgically and pathologically were analysed retrospectively. Results MRI findings of hilar cholangiocarcnoma demonstrated highgrade intrahepatic ductal dilatation and hilar mass. Twelve cases with hilar mass showed progressive enhancement on 3D dynamic contrast enhancement images. One case showed enhancement in arterial phase. The accuracy of MRCP in locating the obstruction was 100%. According to Bismuth categories: type Ⅱ, six cases, type Ⅲa,? two cases, type Ⅲb, three cases, type Ⅳ, two cases. The pathology showed seven cases of high differentiated adenocarcinoma, four cases of media differentiated adenocarcinoma, and two cases of low differentiated adenocarcinoma.Conclusion MRI and 3DCE, combined with MRCP, are valuable in the diagnosis of hilar cholangiocarcinoma. ??? ［KEY WORDS］ Bile duct neoplasms; Magnetic resonance imaging; Cholangiopancreatography, magnetic resonance ??? 肝门部胆管癌是指位于胆囊管开口以上的包括肝总管、左右肝管汇合部和左右肝管的黏膜上皮癌，又称为Klatskin瘤。肝门部胆管癌约占胆管癌的58%～75%，因其特殊的解剖位置及早期侵犯周围血管神经淋巴组织及邻近肝组织的特性，故手术难度大，预后差，因而在术前进行准确的诊断显得非常重要。本文对13例经手术和病理证实为肝门部胆管癌病人的MRI平扫、增强扫描及磁共振胰胆管成像（MRCP）结果进行回顾性分析，以探讨MRI平扫、增强及MRCP在肝门部胆管癌中的诊断价值。 　　1? 资料与方法 　　1.1? 一般资料 ??? 收集经手术和病理证实的肝门部胆管癌病人13例，男9例，女4例，年龄50～86岁，平均58.4岁。临床表现为进行性黄染，逐渐加重，上腹部疼痛，食欲不振,乏力和体质量下降。其中1例曾行胆总管结石清除术。所有病例均有B超和CT诊断结果相印证。 　　1.2? 方法 ??? 使用SIEMENS Symphony P 1.5 T超导型磁共振扫描仪，MRI平扫行冠状位和横轴位扫描：T2WI TR 1 100