摘要
目的：研究MRI、MRCP对胆道梗阻恶性肿瘤的诊断价值，并与病理类型对照。方法：46例胆道梗阻恶性肿瘤患者，常规T1WI、T2WI及脂肪抑制T2WI检查后，行MRCP检查。分析不同部位胆道梗阻恶性肿瘤的MRI、MRCP表现与病理类型对照。结果：46例患者，4例MRCP仅肝内胆管扩张，肿块T2WI高信号，病理均为肝内胆管细胞癌；10例MRCP肝门“空虚征”、肝内胆管枯树枝状扩张，肿块T2WI高信号7例，病理为胆管癌6例，胆囊癌4例；16例胆总管中段截断，近段胆管、肝内胆管扩张，肿块T2WI稍高信号6例，病理为胆管癌9例、胆囊癌3例、胰头癌2例、十二指肠腺癌2例；16例胆管末段截断或狭窄，T2WI稍高信号8例，病理改变为胰头癌4例、十二指肠乳头腺癌4例、胆管癌3例、壶腹癌5例。结论：恶性肿瘤性胆道梗阻有不同的MRI和MRCP表现，反映其病理类型。常规MRI和MRCP联合应用有利于恶性肿瘤性胆道梗阻的定位、定性诊断。
Abstract
Objective: To investigate the value of conventional magnetic resonance imaging(MRI) and magnetic resonance cholangiopancreatography(MRCP) in diagnosing biliary tract obstruction by malignant tumor as well as correlate with pathology. Methods: Forty-six cases were included in this study, MRCP were performed following T1WI, T2WI and fat-saturation T2WI in each case. Conventional MRI and MRCP appearances of dilatation of bile duct in different locations were compared to its pathology. Results: In 46 cases of malignant biliary tract obstruction, hyperintense signals on T2WI and intrahepatic bile duct dilation on MRCP can be observed in 4 cases, their pathological exams confirmed to be cholangiocarcinoma of the intrahepatic bile duct; hilar defect-sign with proximal bile duct dilation on MRCP in 10 cases of which hyperintense signal mass on T2WI in 7 cases, their pathological exams showed extrahepatic bile duct carcinoma(6 cases) and gallbladder carcinoma(4 cases) by pathology. In 16 cases, abrupt obstruction of middle segment of common bile duct on MRCP of which 6 cases have slight hyperintense signals on T2WI, their pathological exams showed extrahepatic bile duct carcinoma(9 cases) gallbladder carcinoma(3 cases); pancreatic head carcinoma(2 cases); and adenocarcinoma of the duodenum(2 cases). Obstruction or stenosis of distal common bile and pancreatic duct dilation on MRCP can be seen in 16 cases, and only 8 cases of which had slight hyperintense signals on T2WI. their pathological exams proved to be pancreatic head carcinoma(4 cases) and ampullary adenocarcinoma of the duodenum(4 cases) and common bile duct carcinoma(3 cases) and carcinoma of ampulla Vater（5 cases）. Conclusion: Different features of MRCP and MRI can be demonstrated in biliary tract obstruction with malignant tumor, which were related to their pathology. Combination of MRI and MRCP can help the diagnosis of biliary tract obstruction with malignant tumor.
关键词
胆汁淤积 /
消化系统肿瘤 /
胰胆管造影术 /
磁共振 /
磁共振成像
Key words
cholestasis /
digestive system neoplasms /
cholangiopancreatography /
magnetic resonance /
magnetic resonance imaging
殷信道;王利伟;卢玲铨;张 林;张太生;吴前芝;顾建平.
MRCP结合MRI对不同病理类型恶性肿瘤性胆道梗阻的诊断分析[J]. 中国临床医学影像杂志. 2007, 18(9): 624-626
YIN Xin-dao;WANG Li-wei;LU Ling-quan;ZHANG Lin;ZHANG Tai-sheng;WU Qian-zhi;GU Jian-ping.
Evaluation of combining MRCP and MRI in diagnosing biliary tract obstruction with different pathological malignant tumors[J]. Journal of China Clinic Medical Imaging. 2007, 18(9): 624-626
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