CAJ | 학술논문

目的：探讨常规 MRI、磁共振胰胆管水成像(MRCP)、扩散加权成像(DWI)以及增强 MRI 联合应用在复发性化脓性胆管炎(RPC)诊断中的临床价值。方法回顾性分析21例经手术或穿刺证实的 RPC 患者的临床和 MRI 资料。21例均进行常规MRI(FSE T2 WI、FSPGR T1 WI、FIASTA)、MRCP和DWI,其中12例采用肝容积加速采集序列(LAVA)进行三维容积动态增强扫描。原始数据经 GE ADW4.4工作站处理后,对三维 MRCP、DWI进行分析。结果(1)21例均显示肝内胆管结石伴不规则扩张,累及左侧肝内胆管11例,右侧肝内胆管7例,左右肝内胆管均累及3例；胆管壁增厚19例,胆管壁厚度正常2例。(2)胆总管病变：肝内外胆管结石伴胆管扩张8例、单独肝内胆管结石13例。(3)胆囊病变：胆囊结石5例,慢性胆囊炎9例,急性胆囊炎3例,胆囊切除4例。(4)肝实质病变：肝叶萎缩6例,其中左叶萎缩4例,右叶萎缩2例。扩张胆管周围炎性改变12例,在常规扫描T2 WI呈斑片状稍高信号,在DWI上高信号影扩大,动态增强动脉期表现为均匀性轻度强化,门脉期及延迟期强化逐渐增强。结论多序列 MRI能够较全面反映 RPC的病理变化,对于该病的影像诊断具有较重要的诊断价值。
목적：탐토상규 MRI、자공진이담관수성상(MRCP)、확산가권성상(DWI)이급증강 MRI 연합응용재복발성화농성담관염(RPC)진단중적림상개치。방법회고성분석21례경수술혹천자증실적 RPC 환자적림상화 MRI 자료。21례균진행상규MRI(FSE T2 WI、FSPGR T1 WI、FIASTA)、MRCP화DWI,기중12례채용간용적가속채집서렬(LAVA)진행삼유용적동태증강소묘。원시수거경 GE ADW4.4공작참처리후,대삼유 MRCP、DWI진행분석。결과(1)21례균현시간내담관결석반불규칙확장,루급좌측간내담관11례,우측간내담관7례,좌우간내담관균루급3례；담관벽증후19례,담관벽후도정상2례。(2)담총관병변：간내외담관결석반담관확장8례、단독간내담관결석13례。(3)담낭병변：담낭결석5례,만성담낭염9례,급성담낭염3례,담낭절제4례。(4)간실질병변：간협위축6례,기중좌협위축4례,우협위축2례。확장담관주위염성개변12례,재상규소묘T2 WI정반편상초고신호,재DWI상고신호영확대,동태증강동맥기표현위균균성경도강화,문맥기급연지기강화축점증강。결론다서렬 MRI능구교전면반영 RPC적병리변화,대우해병적영상진단구유교중요적진단개치。
Objective To investigate the clinical value of the combination of routine magnetic resonance imaging (MRI),magnetic resonance cholangiopancreatography (MRCP),diffusion weighted imaging (DWI)and enhanced magnetic resonance imaging in the diagnosis of recurrent pyogenic cholangitis (RPC).Methods The clinical and MRI data of 2 1 cases of RPC confirmed by surgery or puncture were retrospectivly analyized.Results All of 2 1 patients were performded with routine MRI (FSE T2 WI,FSPGR T1 WI and FIASTA),MRCP and DWI.1 2 cases were underwent three-dimensional dynamic contrast-enhanced MRI with a liver volume accelerated acquisition sequence (LAVA).The raw data was uploaded to GE ADW4.4 station and the three dimensional MRCP and DWI were analyzed.(1)All of 21 cases were hepatolithiasis complicated with irregular expansion.11 cases were involved left intra-hepatic bile duct,7 cases were right intrahepatic duct,and 3 cases were involved left and right intrahepatic bile duct.Wall thickening was in 19 cases,normal biliary duct wall was in 2 cases.(2)Common bile duct disease:calculus of intrahepatic and extrahepatic bile duct complicated with bile duct dilatation were in 8 cases.Calculus of intrahepatic bile duct were individually in 13 cases.(3)Gall-bladder disease:there were 5 cases of gallstone,9 cases of chronic cholecystitis,3 cases of acute cholecystitis and 4 cases of chole-cystectomy.(4)Liver parenchyma disease:there were 6 cases of liver atrophy in all the cases (left lobe atrophy of 4 cases,right lobe atrophy of 4 cases).The inflammatory changes around dilated bile ducts were found in 1 2 cases.The MRI findings of those were slight patchy hyperintensity signal on conventional T2 WI,the area of hyperintensity signal on T2 WI was extended on DWI.On dynamic contrast-enhanced MRI,the inflammatory areas were uniformity minor enhancement on arterial phase,and hardening in-creases on portal and delayed phase.Conclusion Multi-sequences MRI can be more fully reflected the pathologic changes of RPC, which is important for imaging diagnosis of the disease.