CAJ | 학술논문

目的探讨弥散加权成像(DWI)及表观弥散系数(ADC)值在原位肝移植术后缺血性胆管病变中的应用价值.方法以PTC或ERCP检查,病理或临床定期随访资料为标准,筛选出中山大学附属第三医院2005年4月至2009年3月46例肝移植术后患者,将其分为缺血性胆管病变组(TTBL组,29例)和无缺血性胆管病变组(C组,17例),测量移植肝实质的ADC值(b值=600 s/mm2),并对DWI序列上移植肝胆道系统信号和MRCP上胆管树进行观察.结果 ITBL组和C组的移植肝ADC值分别为(1.456±0.286)×10-3mm2/s和(1.716±0.391)×10-3mm2/s,ITBL组ADC值低于C组,两组间差异有统计学意义(P=0.015).DWI上ITBL组和C组胆管壁信号增高发生率分别为82.8%(24/29)和5.9%(1/17),ITBL组DWI上胆道壁信号增高主要发生在肝门部胆管及肝内小胆管(70.8%,17/24).ITBL组与C组之间差异有统计学意义(P＜0.001).ITBL组21例伴发胆泥,DWI上呈高、等、低信号,C组中胆管管腔内未见异常信号.结论 DWI上ITBL主要表现为肝门部及肝内小胆管管壁信号明显增高,移植肝ADC值下降,可在一定程度上反映其病理学改变,可能对ITBL的早期诊断是一种有效的、敏感的监测指标.DWI作为一种新颖、无创、简单、实用的方法在肝移植术后ITBL的诊断、鉴别诊断具有重要的临床意义.
목적 탐토미산가권성상(DWI)급표관미산계수(ADC)치재원위간이식술후결혈성담관병변중적응용개치.방법 이PTC혹ERCP검사,병리혹림상정기수방자료위표준,사선출중산대학부속제삼의원2005년4월지2009년3월46례간이식술후환자,장기분위결혈성담관병변조(TTBL조,29례)화무결혈성담관병변조(C조,17례),측량이식간실질적ADC치(b치=600 s/mm2),병대DWI서렬상이식간담도계통신호화MRCP상담관수진행관찰.결과 ITBL조화C조적이식간ADC치분별위(1.456±0.286)×10-3mm2/s화(1.716±0.391)×10-3mm2/s,ITBL조ADC치저우C조,량조간차이유통계학의의(P=0.015).DWI상ITBL조화C조담관벽신호증고발생솔분별위82.8%(24/29)화5.9%(1/17),ITBL조DWI상담도벽신호증고주요발생재간문부담관급간내소담관(70.8%,17/24).ITBL조여C조지간차이유통계학의의(P＜0.001).ITBL조21례반발담니,DWI상정고、등、저신호,C조중담관관강내미견이상신호.결론 DWI상ITBL주요표현위간문부급간내소담관관벽신호명현증고,이식간ADC치하강,가재일정정도상반영기병이학개변,가능대ITBL적조기진단시일충유효적、민감적감측지표.DWI작위일충신영、무창、간단、실용적방법재간이식술후ITBL적진단、감별진단구유중요적림상의의.
Objective To discuss the application values of DWI (diffusion-weighted imaging) and ADC (apparent diffusion coefficient ) on ischemic-type biliary lesions (ITBL) after orthotopic liver transplantation. Methods According to whether there was ITBL after liver transplantation or not, 46 cases of liver transplantation were selected and divided into 2 groups on the basis of PTC (percutaneous transhepatic cholangiography ) or ERCP (endoscopic retrograde cholangiopancreatography ) examination,pathology or clinical follow-up data: ITBL group ( n = 29 ) and no ITBL group ( C group, n = 17). The ADC value was measured for right lobe of graft liver parenchyma ( b value =600 s/mm2 ). And the signal of biliary system of graft on DWI and biliary tract on MRCP were analyzed. Results ( 1 ) The ADC values of liver graft were ( 1. 456 ± 0. 286 ) × 10 -3 mm2/s and ( 1. 716 ± 0. 391 ) × 10 -3 mm2/s in ITBL and C groups respectively. The difference in ADC value was significant between two groups ( P = 0. 015 ); ( 2 ) the incidence of increased signal of bile duct on DWI was 82. 8% ( 24/29 ) and 5.9% ( 1/17 ) for ITBL and C groups respectively. The lesion was located in porta hepatis and intrahepatic small bile duct was seen in 17 of 24 patients (70. 8% ) in ITBL group. The difference was significant in signal of bile ducts between ITBL and C groups ( P ＜ 0. 001 ). Twenty-one cases with sludge on DWI in ITBL group had hyperintensity, isointensity or hypointensity. There was no abnormal signal in the lumen of bile duct in C group. Conclusion The major sign of ITBL is a hyperintensity of porta hepatis and small bile ducts on DWI. And the ADC value of graft liver parenchyma decreases. These reflect the pathological changes to an extent and may be an effective and sensitive monitoring tool of early ITBL. DWI is a novel, non-invasive, simple and practical method in the diagnosis and differential diagnosis of ITBL after liver transplantation.