Diagnosis Of MRCP In The Biliary Obstructive Diseases

Objective To assess the clinical value of the visualization ability of the pancreatobiliary tract and in diagnostic of the biliary obstructive diseases with heavily T2-weighted fast spin-echo (HT2-FSE) and the single-shot fast spin-echo(SS-FSE) sequences.Materials and Methods 79 patients with obstructive jaudice for patient group (male 52cases , female 27 cases, mean age 40 years , age rang 4 months~80 years) and 30 volunteers for control group(male 18, female 12, mean age 28 years , rang 20-36 years ) were performed on MRCP between January 2001 and February 2003 in our hospital. Patient group were confirmed diagnosis by pathology in 60 cases and final diagnosed by ERCP and CT, B-echo in 19 cases. The Patient group was divided into two groups: benign bile duct obstructive group in 41 cases, including 25 cases of cholelithiasis, 5 cases of cholangitis stenosis, 5 cases of congenital cholangiectasis, 3 cases of liver flukes, 2 cases of chronic pancreatitis, 1 case of biliary stenosis due to lobectomy of left liver, and malignant bile duct obstructive group in 38 cases, including 25 cases of cholangiocarcinoma(porta hepatis carcinoma in 8 cases, common bile duct carcinoma in 8 cases, ampulla carcinoma in 9 cases), 6 cases of pancreatic carcinoma, 6 cases metastases from hepatoma, 1 case of canceration due to chronic cholelithiasis. The two groups MRCP results were comparaed with reference examination in 79cases. HT2-FSE(TR:5000ms, TE:182ms, ETL 14,FOV 28 28, Matrix 256 192, slice thickness 3mm, spacing 0, scan time 4-6 minuts, acqusition of multiple planes) and SS-FSE (TR:maximum, TE:1145-1155ms, FOV:34 34, slice thickness 50~100mm, scan time l~3second) sequencesat were employed in the two groups in the MR scanner of GE Signal 1. 5T/i with suface coil. MRCP was obtained by MIPreconstruction in HT2-FSE. Study item: 1. to investigate display rate of gallbladder, intrahepatic and extrahepatic bile duct, and pancreatic duct, and to measure diameters of the bile duct in the MRCP of the HT2-FSE and SS-FSE in the two groups respectively. 2. to study relation between size of dilation bile duct with cause of biliary obstruction. 3. to observe characteristics of obstruction and stenosis of bile duct on the MRCPs in patient group. 4. to analyse the diagnosis accuracy in HT2-FSE and SS-FSE comparing with results of surgery. 5. Statistical analysis used SPSS for 10.0, P<0.05 was signifcantly,P<0. 01 was highly signifcantly.Result Both of the MRCP with HT2-FSE and SS-FSE sequence were successfully, presenting highest-signal-intensity in bile ducts and pancreatic duct in the control group. There were no statistical differences between two MRCPs with HTVFSE and SS-FSE sequence in visualization rate of the common bile duct,gallbladder and cholecyst duct. But MRCP with HT2-FSE had lower sensitivity in visualization of normal secondary intrahepatic bile duct (70%, 21/30), main pancreatic duct (30%, 9/30), cholecyst duct (86. 7%, 26/30), and the convergent duct of ampullu and pancreatic duct (60%, 18/30) than that of the MRCP with SS-FSE (90%, P<0. 01). The MRCP shown a diameter of 1 mm -2mm in intrahepatic duct, l~3mm in left or right hepatic duct, 3~8mm in common bile duct and 1-3mm in pancreatic duct and 5.6 cmx3. 5 cm 1.085 in size of gallbladeder in the control group. The diameter of the pancreatobiliary duct on the MRCP with SS-FSE shown smaller significantly than that on the MRCP with HT2-FSE. 2. MRCP with HT2-FSE and SS-FSE sequence were also successfully performed in 79 cases and stenosis or obstructive location and filling defect with dilation of pancreaticobiliary ducts were visualizated clearly. The dilation of bile duct, the diameter from 11 mm to 72mm(slight dilation in 33 cases and severe dilated in 34 cases), looked like branch in 11 cases and like soft vine in 49 cases. The direct cholerythrin shown a positive correlation(pearson analysis, r=0. 98, P<0. 01) with the dilation degree of biliary duct in 15 cases. The obstructive position was detected in porta hepatis in 26 cases, middle common bole duc...