Application Of Hypotonic MR In Obstruction Of Ampullary Portion Of Choledoch

Objective To explore the clinic value of hypotonic MR scan in patient with obstruction in ampullary portion of choledoch. To analyze the infection of hypotonic and enhanced MR scan in the quality of the MR image. To analyze the accuracy of location of focus and reliability of determining focus of the obstruction in ampullary portion of choledoch in MR scan with hypotonic medicine or MR scan without hypotonic medicine. To compare the clinic possibility of hypotonic druggery of 654-2 and scopolamine butylbromide injection in MR scan.Methods and materials The data of hypotonic and enhanced MR scan were prospective and evaluated in 98 patients with obstruction in ampullary portion of choledoch. All lesions of digestive tract were proved in surgery,pathology, clinical following up. Including654-2(73) , scopolamine butylbromide injection(25) . The data of hypotonic MR scan were evaluated in 98 patients with obstruction in ampullary portion of choledoch. Male group(38 cases) and Female group (22 cases). The mean age of all 98 cases was 54．42(range,28～82) years. MR imaging equipment is GE 1．5T SIGNA. scaning FSE-T2WI,SSFSE-T2WI,SPGR-T1WI sequence. Hypotonic MR scan is startuped after 8 minute injecting hypotonic medicine with water(100-200 ml) ,That isn't sure of the pathogeny of the obstruction in ampullary portion of choledoch. The diagnosis standard of the obstruction in ampullary portion of choledoch: The degree of dilated common duct could be divided into three categories ( low, middle, and marked grade ). To analyze the infection of hypotonic and enhanced MR scan with water in the quality of the MR image of MR scan with hypotonic medicine or MR scan without hypotonic medicine. The hypotonic MR scan decides the accuracy of location of focus and reliability of determining focus of the obstruction in ampullary portion of choledoch by self control.Results Images analysis:the image quality of MRCP and MRI were analyzed and compared by two radiologists respectively in double-blind method. The motion artifact by intestines is disappear in the images of hypotonic MR scan, that was significant difference(P <0．05) between hypotonic MR scan and MR scan without hypotonic medicine. There was significant difference(P>0．05) between hypotonic MR scan with 654-2 and MR scan with scopolamine butylbromide injection. The manifestation of the ampullae demonstrating anatomy in hypotonic MR scan are classified into four grades. In hypotonic group , the ability of demonstrating anatomy had been greatly improved (p < 0．05) ;There was significant difference(P>0．05) of demonstrating anatomy between MR scan with 654-2 and MR scan with scopolamine butylbromide injection. The demonstration of adjacent organs and structure to the digestive tract in hypotonic MR scan are classified into three grades,mosty including distal common bile duct, head of pancreas, descending part of duodenum,behind of peritoneum. It also improved in demonstration of adjacent organs and structure to the digestive tract (P<0．05) . Significant difference(P>0．05) between MR scan with 654-2 and MR scan with scopolamine butylbromide injection. The direct manifestation of the obstruction in ampullary portion of choledoch in hypotonic MR scaned: low-grade dilatation of choledoch (25 cases), middle-grade dilatation (42 cases), and marked-grade dilatation (23 cases). In duct, 'soft bine'dilatation (20 cases), 'nub'dilatation (40 cases), and atypical dilatation(31 cases). In the ampullary carcinoma, there were'double pipe'sign in 13, and'half-moon'sign in 8．The soft tissue nodus of parenchyma with pap-illa could be seen in the dilated sections of dropp ing of duodenum in 12 cases. Manifestations on dynamic enhancement scan(17 cases), no marked enhancement(1 cases). Low signal Choledocholithiasis(n = 35) , MRCP manifestations on obstructed end of common bile duct of stenosis of cholangitic of the distal common bile (n=20),postcholecystectomy of terminal common bile duct(n =5) and duodenal diverticulum(n = 3) : funnel shape or ring-like narrowness. Manifestations of the duodenal papillitis (n= 5) and duodenal ampullary inflammatory edema (n= 5) : duodenalpapilla swell and no marked enhancement. The accuracy of location of focus and reliability of determining focus of the obstruction in ampullary portion of choledoch hypotonic MR scan are increase(P<0．05) . There was significant difference(P>0．05) of the accuracy of location of focus and reliability of determining focus of the obstruction in ampullary portion of choledoch between MR scan with 654-2 and MR scan with scopolamine butylbromide injection.Conclusion 1．Hypotonic MR scan can improve the quality of MRCP and MRI images.2．Hypotonic MR scan can increase the accuracy of location of focus and reliability of determining focus of the obstruction in ampullary portion of choledoch, that is a important method in the obstruction.3．654-2 and scopolamine butylbromide injection are taked as ideal hypotonic medication.Because 654-2 is more benefit than scopolamine butylbromide injection,654-2 is recommended as the first medicine.4．The direct manifestation of the obstruction is display distinctly in hypotonic MR scan, That is clinic applied value of the diagnosis and differential diagnosis of the obstruction in ampullary portion of choledoch.