CAJ | 학술논문

目的探讨三维快速梯度回波T1加权磁共振成像序列(volumetric interpolated breath-hold examination, 3D-VIBE)在术前评价肝门胆管癌的诊断价值.方法前瞻性纳入并经随后手术证实的31例肝门胆管癌患者术前行上腹部综合磁共振 (magnetic resonance imaging, MRI)检查,序列包括快速自旋回波T2加权(T2 weighted, T2W)、二维(two dimension, 2D)梯度回波T1加权(T1 weighted, T1W)平扫, 2D 磁共振胆胰管成像(magnetic resonance cholangiopancreatography, MRCP),Gd对比剂(Gd-DTPA)增强的3D-VIBE三期动态扫描和增强2D T1W(平衡期).分析肿瘤的形态、胆管侵犯范围和有无血管侵犯,并比较3D-VIBE和2D T1W 序列判断能否手术根治性切除肿瘤的可靠性.结果 ①3D-VIBE序列直接显示了所有31例病例的肝门部肿瘤,并准确判断形态学分类;8例浸润型肝门胆管癌病例在2D T1W 序列增强图像上肿瘤未获直接显示(25.8%).②根据Bismuth-Corlette分类法,3D-VIBE显示胆管纵向侵犯范围的准确性接近MRCP (93.5%),而常规2D T1W增强图像倾向于低估胆管侵犯范围 (32.3%).③3D-VIBE显示了更多的肝动脉、门静脉及其分支侵犯.④在判断本组肝门胆管癌病例能否手术切除方面,3D-VIBE序列阳性预测值为84.2%,准确性为90.3%;2D T1W序列分别为64.0%和71.0%.结论 3D-VIBE在判断肝门胆管癌形态学类型、胆管纵向侵犯范围和手术切除性等方面优于其它MRI序列.
목적 탐토삼유쾌속제도회파T1가권자공진성상서렬(volumetric interpolated breath-hold examination, 3D-VIBE)재술전평개간문담관암적진단개치.방법 전첨성납입병경수후수술증실적31례간문담관암환자술전행상복부종합자공진 (magnetic resonance imaging, MRI)검사,서렬포괄쾌속자선회파T2가권(T2 weighted, T2W)、이유(two dimension, 2D)제도회파T1가권(T1 weighted, T1W)평소, 2D 자공진담이관성상(magnetic resonance cholangiopancreatography, MRCP),Gd대비제(Gd-DTPA)증강적3D-VIBE삼기동태소묘화증강2D T1W(평형기).분석종류적형태、담관침범범위화유무혈관침범,병비교3D-VIBE화2D T1W 서렬판단능부수술근치성절제종류적가고성.결과 ①3D-VIBE서렬직접현시료소유31례병례적간문부종류,병준학판단형태학분류;8례침윤형간문담관암병례재2D T1W 서렬증강도상상종류미획직접현시(25.8%).②근거Bismuth-Corlette분류법,3D-VIBE현시담관종향침범범위적준학성접근MRCP (93.5%),이상규2D T1W증강도상경향우저고담관침범범위 (32.3%).③3D-VIBE현시료경다적간동맥、문정맥급기분지침범.④재판단본조간문담관암병례능부수술절제방면,3D-VIBE서렬양성예측치위84.2%,준학성위90.3%;2D T1W서렬분별위64.0%화71.0%.결론 3D-VIBE재판단간문담관암형태학류형、담관종향침범범위화수술절제성등방면우우기타MRI서렬.