论文部分内容阅读
目的探讨磁共振三维容积式内插值法屏气检查(MRI 3D-VIBE)序列联合磁共振胆胰管成像(MRCP)在胰胆管十二指肠连接区癌(PDDUC)诊断和鉴别诊断中的价值。方法59例经手术病理或临床随访证实的PDDUC患者(胰头癌34例,胆总管下段癌14例,壶腹癌11例),行常规MRI、MRCP及3D-VIBE动态增强扫描,观察肿瘤形态学特点;计算病灶的信噪比(SNR)及对比噪声比(CNR);测量胰胆管汇合角、胰胆管末端间距、十二指肠主乳头至扩张的胰胆管末端的距离、胆总管直径、胰管直径。结果胰头癌、胆总管下段癌和壶腹癌3组间病灶最大径、中心位置、边缘情况和病灶均匀度,差异有统计学意义(P<0.05)。胰头癌较易累及胰周血管,胆总管下段癌和壶腹癌均未见邻近血管受累征象。胰头癌组的胰胆管汇合角度、十二指肠主乳头至胰胆管梗阻端的距离及胰胆管末端间距均大于胆总管下段癌和壶腹癌组;“四管征”多见于胰头癌。门脉期胆总管下段癌SNR高于胰头癌和壶腹癌组(P<0.05),动脉早期和动脉晚期3组间比较差异无统计学意义。门脉期胆总管下段癌信号强度稍高于胰腺实质。结论MRI 3D-VIBE序列联合MRCP能较好显示不同类型PDDUC的形态学特征和强化特点,能较好显示胰胆管的细微差别,有助于胰头癌、胆总管下段癌和壶腹癌的诊断和鉴别诊断。
Objective To investigate the value of MR 3D-VIBE combined with magnetic resonance cholangiopancreatography (MRCP) in the diagnosis and differential diagnosis of pancreaticoduodenal junctional carcinoma (PDDUC). Methods Fifty-nine PDDUC patients (34 with pancreatic head cancer, 14 with choledocholithiasis and 11 with ampulla carcinoma) confirmed by pathology or clinical follow-up were examined with routine MRI, MRCP and 3D-VIBE dynamic contrast-enhanced scanning (SNR) and contrast-to-noise ratio (CNR) of lesion were calculated; the confluence angle of pancreaticobiliary duct, end of pancreaticobiliary duct, distance of duodenal main papilla to the end of expanded pancreaticobiliary duct, diameter of common bile duct, Pancreatic duct diameter. Results There were significant differences in the maximum diameter, the center position, the margin and the lesion evenness among the three groups (P <0.05) of pancreatic carcinoma, lower bile duct carcinoma and ampulla carcinoma. Pancreatic cancer more likely to affect pancreatic vessels, common bile duct cancer and ampullary carcinoma showed no signs of adjacent vascular involvement. The pancreaticobiliary duct confluence angle, the distance from the duodenal main papilla to the pancreaticobiliary duct obstruction and the end of the pancreaticobiliary duct were greater than those in the lower common bile duct carcinoma and ampullary carcinoma group. cancer. The lower SNR of the common bile duct in the portal venous phase was higher than that in the pancreatic head cancer and ampulla carcinoma (P <0.05). There was no significant difference in the early arterial phase and late arterial phase between the three groups. Portal venous phase lower bile duct cancer signal intensity slightly higher than the parenchyma. Conclusion MRI 3D-VIBE sequence combined with MRCP can better show the morphological characteristics and enhancement characteristics of different types of PDDUC, which can better show the slight differences of pancreaticobiliary duct and help diagnosis of pancreatic head cancer, lower common bile duct cancer and ampullary carcinoma And differential diagnosis.