【摘要】 目的:探讨低张胰胆管水成像(magnetic resonance cholangiopancreatography,MRCP)结合Pro-pellerLAVA多期动态增强扫描在壶腹周围病变综合诊断中的临床应用价值。方法:对34例壶腹周围病变患者在常规MR扫描基础上行低张MRCP及十二指肠低张后PropellerLAVA多期动态增强扫描,对原始图像进行3DMIP及MPR重建后处理,观察病变的间接及直接征象并与临床随访及病理结果对照。结果:34例中31例梗阻性质诊断明确,1例胰头癌漏诊,2例炎症误诊为肿瘤,定性诊断准确率为91.2%。30例行PropellerLAVA增强扫描,直接征象显示率达93.3%,肿瘤浸润范围诊断符合率为80.8%。26例肿瘤性病变中壶腹部癌5例,胆总管远端癌11例、胰头癌9例、壶腹周围十二指肠腺癌1例,定位准确率分别为88.5%(23/26)、84.6%(22/26)、88.5%(23/26),十二指肠腺癌误诊为乳头癌。另外直观显示了4例病变局限、直径在2.0cm以内的早期壶腹周围癌。结论:低张MRCP结合PropellerLAVA动态增强扫描能够全面、直观显示壶腹部病变的间接及直接征象,在明确肿瘤性病变的范围及周围组织、血管浸润方面具有重要意义,对壶腹部较小或隐匿病变亦具有较高的应用价值。更多还原

【Abstract】 Objective: To discuss the value of hypotonic-MRCP combined with Propeller LAVA dynamic multi-phase enhancement scanning in the synthetic diagnosis of periampullary diseases. Methods: Thirty-four patients with periampullary diseases underwent MRI examination after duodenum was in hypotonicity, and then examined with hypotonic-MRCP and Propeller LAVA dynamic multi-phase enhancement scanning. The original images was reformed by MIP and MPR. The direct and indirect signs were observed and compared with the clinical and pathologic results. Results: In 34 cases, 31 cases were clearly diagnosed, 1 carcinoma of pancreas head was missed, 2 inflammations were misdiagnosed as tumor. Thirty cases underwent Propeller LAVA dynamic multi-phase enhancement scanning, the direct sign rate was 93.3% and the extension diagnose rate was 80.8%. In 26 tumor cases, there were 5 ampullary carcinomas, 11 cholangiocarcinomas, 9 carcinoma of head of pancreas, 1 adenocarcinoma of duodenum). Conclusion: Hypotonic-MRCP combined with Propeller LAVA dynamic multi-phase enhancement scanning might display the direct and indirect sign , which was effective in identifying the circumscription of the tumor and its extensionof periampullary diseases.更多还原