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目的探讨磁共振弥散加权成像(DWI)联合三维容积内插值屏气检查(3D-VIBE)在评价肝门胆管癌淋巴结转移中的价值。方法收集2009年7月至2011年3月行上腹部磁共振成像(MRI)检查并经手术、病理学检查证实的连续性肝门胆管癌病例37例,比较DWI和VIBE序列对淋巴结显示的差异,分析淋巴结的形态及分布情况。在DWI序列上测量淋巴结的信号强度(SI)并计算表观弥散系数(ADC),在3D-VIBE图像上测量淋巴结与肝实质SI之比(SI淋巴结/SI肝脏),对转移性与非转移性淋巴结的差异进行比较。结果 37例患者59组淋巴结中,51组在DWI和3D-VIBE序列上均显示,8组仅在一种序列图像上显示,两种序列图像淋巴结显示率的差异无统计学意义(P=0.070)。在DWI轴位像和3D-VIBE增强扫描图像上,所有显示淋巴结的短径分别为(0.82±0.27)cm和(0.79±0.26)cm,两者的差异无统计学意义(P=0.628)。3D-VIBE图像上,转移性淋巴结的短径为(1.05±0.42)cm,明显大于非转移性淋巴结〔(0.78±0.22)cm〕,P=0.030。转移性淋巴结的ADC值为(1.64±0.30)×10-3mm2/s,明显小于非转移性淋巴结的ADC值〔(2.28±0.79)×10-3mm2/s〕,P=0.033。动态增强扫描门静脉期转移性与非转移性淋巴结的SI淋巴结/SI肝脏分别为1.24±0.31和1.33±0.25,3 min延迟期转移性与非转移性淋巴结的SI淋巴结/SI肝脏分别为1.34±0.28和1.19±0.15,差异均无统计学意义(P=0.368,P=0.081)。在DWI序列图像中,随着b值增大,图像的SI逐渐降低。结论 DWI和3D-VIBE序列检测的ADC值及淋巴结短径的差异对于鉴别肝门胆管癌淋巴结转移具有一定价值,联合DWI、3D-VIBE序列能够更准确地评价肝门胆管癌淋巴结转移情况。
Objective To investigate the value of 3D diffusion weighted imaging (DWI) combined with three dimensional volume interpolation (3D-VIBE) in the evaluation of lymph node metastasis of hilar cholangiocarcinoma. Methods Totally 37 consecutive cases of hilar cholangiocarcinoma proved by MRI and pathological examination from July 2009 to March 2011 were collected. The differences between DWI and VIBE sequences in lymph nodes were compared , Analysis of lymph node morphology and distribution. The signal intensity (SI) of the lymph nodes was measured on the DWI sequence and the apparent diffusion coefficient (ADC) was calculated. The ratio of lymph nodes to hepatic parenchymal SI (SI lymph nodes / SI liver) was measured on the 3D-VIBE images and the metastatic and non-metastatic Differences in sexual lymph nodes were compared. Results Among the 59 patients with lymph node metastases, 51 of the 37 patients showed DWI and 3D-VIBE sequences, 8 of them showed only one sequence of images and no significant difference was found between the two sequences (P = 0.070 ). On the DWI axial images and 3D-VIBE enhanced images, the short diameters of all the lymph nodes were (0.82 ± 0.27) cm and (0.79 ± 0.26) cm, respectively. There was no significant difference between them (P = 0.628). On 3D-VIBE images, the short diameter of metastatic lymph nodes was (1.05 ± 0.42) cm, which was significantly larger than that of non-metastatic lymph nodes (0.78 ± 0.22) cm, P = 0.030. The ADC value of metastatic lymph nodes was (1.64 ± 0.30) × 10-3mm2 / s, which was significantly lower than that of non-metastatic lymph nodes 〔(2.28 ± 0.79) × 10-3mm2 / s〕, P = 0.033. The SI lymph nodes / SI liver in metastatic and non-metastatic lymph nodes with dynamic contrast-enhanced scanning were 1.24 ± 0.31 and 1.33 ± 0.25 respectively in the delayed phase of metastatic and non-metastatic lymph nodes with a delay of 1 min and 1.34 ± 0.28 And 1.19 ± 0.15, the difference was not statistically significant (P = 0.368, P = 0.081). In the DWI sequence image, the SI of the image gradually decreases as the b value increases. Conclusion The differences of DWI and 3D-VIBE in detecting ADC value and lymph node short-cut have some value in differentiating hilar cholangiocarcinoma from lymph node metastasis. Combining DWI and 3D-VIBE sequences can evaluate the lymph node metastasis of hilar cholangiocarcinoma more accurately.