【作者】 邓敏；

【导师】 金科；

【作者基本信息】 南华大学 ， 影像医学与核医学（专业学位）， 2017， 硕士

【摘要】 目的:探讨磁共振黑血SPACE序列与MRCP、T2-HASTE在婴幼儿胆道成像中的对比应用价值。材料与方法:选择30例对照组和12例病例组(2016年3月至2016年9月间来我院就诊的婴幼儿);对照组纳入标准为未患胆道系统疾病的婴幼儿;病例组纳入标准为临床实验室检查及腹部超声等确诊或怀疑患有胆道系统疾病的婴幼儿;所有研究对象均行全腹部常规MRI序列(包括T2-HASTE)以及黑血SPACE序列、MRCP成像,观察分析并比较黑血SPACE序列与MRCP、T2-HASTE对婴幼儿肝内外胆道解剖结构、门静脉的显示能力以及整体图像伪影的差异。结果:1、对照组图像统计分析,(1)两位放射科诊断医师对黑血SPACE、MRCP、T2-HASTE显示胆道、门静脉能力及整体图像伪影的评分比较采用Kappa一致性检验,黑血SPACE序列的Kappa值大部分超过0.75为高度一致、小部分在0.40-0.75为中高度一致,MRCP的Kappa值基本上均超过0.75为高度一致,T2-HASTE序列Kappa值均在0.40以上一致性中高度。(2)黑血SPACE、MRCP、T2-HASTE显示肝内外胆道结构、门静脉能力的比较:黑血SPACE与MRCP显示胆道结构能力差异无统计学意义,但是黑血SPACE和MRCP对胆囊管(χ~2=11.3570.005<p<0.01,χ~2=8.201 0.01<p<0.025)、左右肝管(χ~2=8.6330.01<p<0.025,χ~2=6.010 0.01<p<0.025)及肝内二级胆管(χ~2=7.9090.01<p<0.025,χ~2=2.781 0.025<p<0.05)的显示能力较T2-HASTE好,黑血SPACE序列显示门静脉的能力较MRCP和T2-HASTE序列更好(χ~2=66.779 p<0.005,χ~2=17.268 p<0.005)。(3)黑血SPACE序列整体图像伪影较T2-HASTE序列多(χ~2=59.63 p<0.001)。2、病例组图像影像分析:黑血SPACE序列较MRCP、T2-HASTE序列更清晰的显示胆道闭锁患儿肝门区及门静脉周围的异常信号影(纤维斑块伴炎性渗出),且门静脉走形、轮廓及边缘显示清晰;黑血SPACE序列在清晰显示胆总管囊状扩张伴或不伴肝内胆管扩张的同时较MRCP拥有更好的软组织对比度;黑血SPACE序列在显示胆总管内充盈缺损区(胆总管结石)的数目、大小、边缘及信号时较T2-HASTE图像清晰。结论:黑血SPACE序列运用于部分婴幼儿胆道成像时存在较多的呼吸运动伪影及肠气干扰,但其基本具备了MRCP和T2-HASTE序列两者的优势,在观察婴幼儿胆道结构形态、轮廓及边缘的同时可以了解毗邻肝组织、血管(门静脉)有无轮廓、边缘及内部信号异常,目前将黑血SPACE序列作为婴幼儿胆道成像的一种补充检查手段,可以为部分胆道系统疾病的诊断及治疗提供有价值的影像信息。更多还原

【Abstract】 Objective:to investigate the application value of magnetic resonance imaging black blood SPACE sequences and MRCP and T2-HASTE in infants with biliary imaging.Materials and methods:30 cases of the control group and the group of 12cases;the control group included in the standard for patients without biliary tract disease,divided into three groups by age(10 neonates,infants and young children group 10 cases a group of 10 cases);group inclusion criteria for clinical laboratory examination and abdominal ultrasound diagnosed or suspected biliary tract disease in infants and young children(including 7 cases of congenital choledochal cyst,3 cases of biliary atresia,2 cases of bile duct calculi);all subjects underwent total abdominal routine MRI sequence(including T2-HASTE)and black blood sequence SPACE MRCP imaging observation,analysis and display ability and overall image artifacts compared with MRCP,T2-HASTE SPACE black blood sequence of extrahepatic biliary tract anatomy,portal vein.Results:The control group of image statistics,the two radiology physicians on SPACE,MRCP and T2-HASTE showed black bile duct,portal vein and image artifacts score compared with Kappa consistency test,black blood sequence of SPACE Kappa value of more than 0.75 for the high degree of consistency,a small part of the 0.40-0.75 in a high degree of consistency,the MRCP value was more than 0.75 Kappa basically is highly consistent with T2-HASTE sequence of Kappa is higher than 0.40 in consistency in height.The SPACE,MRCP and T2-HASTE showed blood biliary structure,portal vein ability:black blood SPACE and MRCP showed no statistically significant differences in biliary structure ability,but the black blood SPACE and MRCP on gallbladder tube(χ~2=11.357 0.005<p<0.01,χ~2=8.201 0.01<p<0.025),Left and right hepatic duct(χ~2=8.633 0.01<p<0.025,χ~2=6.010 0.01<p<0.025),and in the liver the intrahepatic bile duct(χ~2=7.909 0.01<p<0.025,χ~2=2.7810.025<p<0.05)display ability than T2-HASTE,black SPACE sequence display capability of the portal vein and T2-HASTE sequence is better than MRCP(χ~2=66.779 p<0.005χ~2=17.268 p<0.005,).The whole blood SPACE sequence image artifacts than T2-HASTE sequence(χ~2=59.63 p<0.001).Image analysis of2 cases,like the photos:black blood SPACE sequence with MRCP,T2-HASTE sequence more clearly show abnormal signal around hilar biliary atresia and portal vein(fibrous plaque with inflammatory exudate),and portal vein shape,contour and edge clear display;black SPACE sequence in clearly showed cystic dilatation of the common bile duct with or without intrahepatic bile duct dilation and MRCP has better soft tissue contrast;black SPACE sequence in displaying the filling defect in the common bile duct(CBD stones)the number,size,and edge signal than T2-HASTE images.Conclusion:Although SPACE black blood sequences by respiratory motion artifacts and interference on the part of biliary intestinal gas imaging there are many,but the black SPACE sequences have both MRCP and T2-HASTE series of advantages,at the same time to observe biliary structure,contour and edge can understand the adjacent liver tissue,blood vessels(portal)have no,the contour edges and internal signal abnormalities,the black blood SPACE sequence as a supplementary examination means biliary imaging,imaging can provide valuable information for the diagnosis and treatment of biliary system diseases.更多还原