| Objective Explore the use of heavy three-dimensional turbo spin echo T2 (HT2-TSE3D) and half-Fourier single-shot turbo spin echo (HASTE) sequence of MRCP in the diagnosis of pancreatic duct obstruction disease.Materials and methods Retrospective analysis 52 cases of patients parallel clinical disease biliary obstruction MRCP examination and treatment from September 2007 to March 2010 period. All cases were pathologically confirmed after surgery. Divided the 52 cases into 4 groups according to etiology and imaging findings. (1)Tumor group(21 cases), which included common bile duct cancer(8 cases), hilar cholangiocarcinoma(4 cases), pancreatic cancer(5 cases), ampullary carcinoma(3 cases), metastasis(1 case). (2)Biliary stone(20 cases), which included common bile duct stones(20 cases), combined with hepatolithiasis(10 cases), chronic cholecystitis(9 cases), gallstone(4 cases), pancreatic duct stones(2 cases). (3)Biliary Inflammation(2 cases), which included chronic cholangitis(2 cases). (4)Congenital cystic dilatation of bile duct(9 cases). Use Siemens 1.5T Avanto MRI superconducting scanner to exam patients with fasting and water deprivation 8 hours before examination. Inspection using body phased array coil and breath-hold techniques and fat suppression techniques. Respectively use HT2-TSE3D sequence and HASTE sequence of multi-storey and single scan-line data collection. Multi-dimensional reconstruct the original images and analysis of the imaging findings and diagnosis, compare with surgical results. Research projects:1. esions observed in the two sequences of MRCP on the gallbladder, intrahepatic bile duct, extrahepatic bile duct, pancreatic duct and the lumen size of the display case.2. esions observed in the two sequences of MRCP on the location of bile duct obstruction, bile duct dilatation form and MRCP charactors of obstruction.3. bservation of two sequences of the MRCP showed a direct cause of the obstruction.4. Use x2 test of SPSS 13.0 version statistical software to analysis the correlation between the lesions duct and various performance features, and the MRCP diagnostic accuracy of benign and malignant obstruction. Use t-test to analysis MRCP results of quantitative measurement and operation. P<0.05 as statistically significant difference.Results 1.52 patients with lesions of the HT2-TSE3D and HASTE MRCP imaging of the image is clear. The expansion and the pancreatic duct obstruction(narrow, obstruction or filling defect) was showed clearly. HT2-TSE3D sequence with the original image quality was 96.15%. HASTE sequence quality was 92.30%.2. MRCP showed obstruction of tumor group, which included hilar area(4 cases), pancreatic area(3 cases), pancreas area(11 cases), duodenal papilla area(3 cases). Obstruction of stone group, which included pancreatic area(2 cases), pancreas area(6 cases), duodenal papilla area(12 cases). Obstruction of inflammatory stenosis group were all located in pancreas area. In malignant obstruction group, slight duct dilation was 1 case(4.76%), moderate dilation was 3 cases(14.29%), severe dilation was 17 cases(80.92%). In benign obstruction group, slight duct dilation was 17 cases(77.27%), moderate dilation was 4 cases(18.18%), severe dilation was 1 case(4.55%). In malignant obstruction group, morphology of intrahepatic duct dilation was soft vine like(19 cases,90.48%), withered braches like(2 cases,9.52%), besides, there were also 5 cases of characteristic double duct sign. In benign obstruction group, morphology of intrahepatic duct dilation was soft vine like(1 case,4.55%), withered braches like(21 cases,95.45%). End of obstruction in malignant obstruction group were cut-like mostly(61.90%). End of obstruction in biliary stone group were inverted cup-shaped(6 cases), varying degrees of filling defect(14 cases). End of obstruction in biliary inflammation group were all sharpened like progressive stenosis. Choledochal cyst type I was 6 cases, Choledochal cyst wall section type III was 1 case, Multiple extrahepatic cysts typeâ…£was 1 case, Multiple hepatic cysts(Caroli disease) type V was 1 case.8 cysts were funnel-like stenosis.3. All 52 patients MRCP findings(site of obstruction, bile duct dilatation, stone size, maximum tumor diameters) compared with surgical were no significant difference. HT2-TSE3D and HASTE diagnostic accuracy of localization of bile duct obstruction was 100%. MRCP diagnosis of malignancy was 90.48%. MRCP benign(stone+inflammatory) diagnosis was 90.91%. There were no significant difference.Conclusions 1. MRCP is a non-invasive pancreatic duct non-invasive imaging techniques, clinical application of constantly improved. Interruption of bile duct expansion according to location, accurate positioning to make the diagnosis, accuracy of up to 100%. Location of the lesion, pancreatic duct dilatation, shape, form, and obstruction-side display of the details of the lesion can be a more accurate diagnosis of the disease, and further carry out diagnosis and quantitative measurement.2. MRCP examination in the bile duct obstruction, combined with HT2-TSE3D and HASTE sequences, and True FISP sequence, it can quickly and effectively to provide a clear wealth of diagnostic information. HT2-TSE3D sequences rate of showing good was 96.15%, which is higher than HASTE sequence rate(92.30%).3. The main limitation of MRCP is the reconstructed image easily hide a small lesion, and lack of specific signal in biliary disease, besides, MRCP in the detailed anatomy of the ampulla showed relatively poor. Should pay attention to the original diagnosis of combined MRI and conventional MRI images thin, increase the diagnostic accuracy. |
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