磁共振胰胆管成像联合弥散加权成像诊断婴幼儿胆道闭锁应用研究
Application of magnetic resonance cholangiopancreatography and diffusion-weighted imaging in the diagnosis of infants with biliary atresia
何智 1屈泽东 1刘杰 1牛猛2
作者信息
- 1. 710061 西安市 西北妇女儿童医院医学影像中心
- 2. 兰州大学第一附属医院放射科
- 折叠
摘要
目的 探讨使用磁共振胰胆管成像(MRCP)联合弥散加权成像(DWI)诊断婴幼儿胆道闭锁(BA)的价值.方法 2019 年10 月～2022 年10 月我院诊治的先天性BA患儿40 例,术前接受磁共振成像(MRI)、MRCP和DWI 检查,分析不同检查方式的影像学表现,术中行胆道造影检查.结果 40 例BA患儿经3D-MRCP检查,显示肝外胆管未显影7例(17.5%),胆管细小24 例(60.0%),轻度扩张8 例(20.0%),胆总管囊肿1 例(2.5%).见肝内胆管稀疏或不显影 34例(85.0%),显影6 例(15.0%).显示胆囊细小呈条索状31 例(77.5%),胆囊正常9 例(22.5%);DWI 显示肝外胆管未显影15 例(37.5%),胆管细小19 例(47.5%),轻度扩张5 例(12.5%),胆总管囊肿1 例(2.5%).见肝内胆管稀疏或不显影31 例(77.5%),显影9 例(22.5%).显示胆囊细小29 例(72.5%),正常11 例(28.5%);T2 加权成像显示肝内见三角形影31 例(77.5%),DWI显示肝内呈高信号33 例(82.5%),肝门区高信号为(0.8±0.2)cm;MRI检查显示肝脏右叶增大12 例(30.0%);术中胆道造影显示胆总管、肝总管和肝内胆管不显影 29 例(72.5%),胆总管呈囊状扩张 11 例(28.5%);术中见肝门区纤维组织块36 例(90.0%),平均直径为(1.2±0.5)cm,其中胆囊萎缩33 例(82.5%),肝肿大22例(55.0%),合并肝硬化6 例(15.0%);术中检查诊断Ⅰ型BA1 例(2.5%),Ⅲ型BA 39 例(97.5%),未见Ⅱ型闭锁;MRI、MRCP联合DWI诊断BA正确率为90.5%,显著高于MRI联合 3D-MRCP诊断的 77.5%(P<0.05).结论 MRCP联合DWI 检查诊断婴幼儿BA可全面、直观地显示胆道系统影像,具有较高的临床应用价值.
Abstract
Objective The purpose of this study was to investigate the diagnostic performance of magnetic resonance cholangiopancreatography(MRCP)and diffusion-weighted imaging(DWI)in infants with biliary atresia(BA).Methods 40 children with congenital BA were admitted to our hospital between October 2019 and October 2022,and all underwent MRI,MRCP and DWI scan before operation.The imaging manifestations were recorded,and the diagnostic performances of MRI,3D-MRCP and DWI were compared.Results Out of the 40 children with BA,the 3D-MRCP showed the extrahepatic bile duct undeveloped in 7 cases(17.5%),tiny bile ducts in 24 cases(60.0%),slightly dilated in8 cases(20.0%)and choledochal cyst in1 case(2.5%),the sparse intrahepatic bile ducts or not developed bile ducts in34 cases(85.0%)and developed bile ducts in6 cases(15.0%),the small gallbladder in 31 cases(77.5%)and normal gallbladder in 9 cases(22.5%);the DWI showed the undeveloped extrahepatic bile duct in 15 cases(37.5%),tiny ducts in 19 cases(47.5%),slightly dilated ducts in 5 cases(12.5%),the choledochal cyst in 1 case(2.5%),the sparse or not developed intrahepatic bile ducts in 31 cases(77.5%),the developed ducts in9 cases(22.5%),the tiny gallbladders in29 cases(72.5%)and normal gallbladders in11 cases(28.5%);the T2-weighted imaging showed intrahepatic triangular shadows in 31 cases(77.5%),and the DWI showed high intrahepatic signals in33 cases(82.5%),with the high signal intensity of(0.8±0.2)cm in hilar region;the MRI found the enlarged right lobes of liver in 12 cases(30.0%);the intraoperative cholangiography revealed the undeveloped common bile duct,common hepatic duct and intrahepatic bile duct in 29 cases(72.5%),and the cystic dilatation of common bile ducts in 11 cases(28.5%);during the operation,the fibrous mass in the hilar region was found in 36 cases(90.0%),with the average diameters of(1.2±0.5)cm,and we also found gallbladder atrophy in33 cases(82.5%),the hepatomegaly in 22 cases(55.0%)and liver cirrhosis in 6 cases(15.0%);the diagnosis based on intraoperative examination included BA typeⅰin1 case(2.5%)and BA typeⅲin39 cases(97.5%);the diagnostic accuracy by MRI,MRCP and DWI combination was 90.5%,much higher than 77.5%by MRI and 3D-MRCP(P<0.05).Conclusion The MRCP and DWI scan for infantile biliary atresia could display objectively the whole imaging of biliary system,and have a high diagnostic performance.
关键词
胆道闭锁/磁共振胰胆管成像/弥散加权成像/胆道造影/婴幼儿/诊断Key words
Biliary atresia/Magnetic resonance cholangiopancreatography/Diffusion-weighted imaging/Cholangiography/Diagnosis/Infants and young children引用本文复制引用
基金项目
陕西省科技厅科研计划项目(2021QJ-421)
出版年
2024
国家科技期刊平台
NSTL
万方数据