中国中西医结合影像学杂志

目的 :讨论低张饮水MRCP结合LAVA在低位胆道梗阻性病变中的诊断价值。方法 :对93例经手术或内镜活检病理证实的低位胆道梗阻性病变,行低张饮水MRCP及LAVA动态增强扫描,观察梗阻部位的直接及间接征象。结果:低张饮水MRCP对低位胆道梗阻性病变的显示明显优于常规MRCP,胃肠蠕动伪影差异有统计学意义(P<0.05),对壶腹部以外及壶腹部胆总管显示差异有统计学意义(P<0.01),对周围脏器的显示差异无统计学意义(P>0.05);低张饮水后MRCP对十二指肠憩室诊断率明显提高(P<0.01);结合LAVA动态增强扫描,对低位胆道梗阻性病变的定性诊断准确率分别为72.46%(50/69)、95.65%(66/69)。结论:低张饮水MRCP结合LAVA能够全面且直观显示梗阻部位的直接及间接征象,对明确肿瘤性病变范围及周围组织浸润程度有重要意义。

Objective:To discuss the diagnostic value of MRCP combined with LAVA scan in low levels of biliary obstruction. Methods:Collected 93 patients confirmed by surgery or endoscopic biopsy in the low level biliary obstructive lesions,and took the conventional MR scanning with hypotonic-drinking MRCP and LAVA dynamic enhancement scanning,and then observed the direct and indirect signs of obstruction. Results:The hypotonic-drinking MRCP images of low biliary obstruction lesions were superior to conventional MRCP. The gastrointestinal peristalsis artifact had statistically significant(P< 0.05),the common bile duct outside of the ampullary and common bile duct in the ampullary had more statistically significant(P< 0.01),and on surrounding organs showed no statistical significance(P> 0.05). Before and after hypotonic MRCP,the diagnosis of duodenal diverticulum rate increased significantly(P< 0.01),combined with LAVA dynamic enhanced scanning,of low level biliary obstructive lesions in qualitative diagnosis accuracy rate was 72.46%(50/69),95.65%(66/69),respectively. Conclusion:The combination of MRCP and LAVA can completely and visually display the direct and indirect signs of the obstruction,and it is important to make clear the extent of tumor lesions and the degree of tissue invasion.