CAJ | 학술논문

目的：探讨十二指肠乳头腺癌合并胆道低位梗阻的 MRI 平扫及 MRCP 表现,提高对该病变的诊断水平。方法回顾性分析经手术病理证实的29例十二指肠乳头腺癌的临床及影像资料,所有病例均行常规 T1 WI、T2 WI、DWI 与 MRCP 检查,分析其形态与信号特点及胆道梗阻情况,并将 MRI 诊断结果与手术病理结果进行对照分析。结果29例十二指肠乳头腺癌 MRI 平扫表现为十二指肠乳头区软组织肿块影或结节状影,T1 WI 19例呈稍低信号,10例呈等信号；T2 WI 21例呈稍高信号,8例呈等信号；b=800 s/mm2 DWI 扩散受限呈高或稍高信号。MRCP 表现：胆总管末端呈中断截断,肝内胆管及胆总管扩张20例,可见“软藤征”,肝内外胆管及胰管扩张7例,可见“双管征”,胆总管扩张2例。与病理对照,MRI 诊断病变准确率为83%(24/29)。结论MRI 平扫与 MRCP 能较好地显示十二指肠乳头腺癌合并胆道梗阻,对临床治疗方式的选择具有指导意义。
목적：탐토십이지장유두선암합병담도저위경조적 MRI 평소급 MRCP 표현,제고대해병변적진단수평。방법회고성분석경수술병리증실적29례십이지장유두선암적림상급영상자료,소유병례균행상규 T1 WI、T2 WI、DWI 여 MRCP 검사,분석기형태여신호특점급담도경조정황,병장 MRI 진단결과여수술병리결과진행대조분석。결과29례십이지장유두선암 MRI 평소표현위십이지장유두구연조직종괴영혹결절상영,T1 WI 19례정초저신호,10례정등신호；T2 WI 21례정초고신호,8례정등신호；b=800 s/mm2 DWI 확산수한정고혹초고신호。MRCP 표현：담총관말단정중단절단,간내담관급담총관확장20례,가견“연등정”,간내외담관급이관확장7례,가견“쌍관정”,담총관확장2례。여병리대조,MRI 진단병변준학솔위83%(24/29)。결론MRI 평소여 MRCP 능교호지현시십이지장유두선암합병담도경조,대림상치료방식적선택구유지도의의。
Objective To analyze MRI and MRCP appearances of duodenal papilla adenocarcinoma with low biliary obstruction,in order to improve the diagnosis of this lesion.Methods The clinical data of 29 patients with duodenal papilla adenocarcinoma con-firmed by pathology were retrospectively analyzed.All cases were scanned by un-enhanced MR and MRCP,and the lesion shape,sig-nal characteristics and biliary obstruction of the lesion were analyzed.Results A soft tissue mass or nodule in the duodenal papilla region was showed in 29 cases.On non-enhanced T1 WI,1 9 lesions demonstrated slightly hypointense ,10 lesions were isointensity. On T2 WI,21 lesions were slightly hyperintense,8 lesions were isointensity.On DWI(b=800 s/mm2 ),the lesions were hyperintense or slightly hyperintense.On MRCP,the narrow at the distant end of the common bile duct was showed;20 lesions showed the expan-sion of intra-hepatic bile duct and common bile duct,and showed “soft rattan sign”,7 lesions showed the expansion of the bile duct inside and outside the liver and the pancreatic duct,and “double duct sign”could be seen.2 cases showed the expansion of the com-mon bile duct.Conclusion The combination of non-enhanced MR and MRCP can show duodenal papilla adenocarcinoma with low biliary obstruction .Definite MRI diagnosis of duodenal papilla adenocarcinoma is important for treatment.