Study Of Hypotonic-MRCP Combine With LAVA Dynamic Enhanced MRI In The Diagnosis Of Periampullary Diseases

ObjectiveTo analyze the imaging features of the periampullary diseases by hypotonic-MRCP and Propeller LAVA multi-phase dynamic enhanced sequence of the 3.0T MR, then study the value and predominance of this technique in the diagnosis and preoperative resection evaluation of periampullary diseases, so as to supply reliable imaging information to further increase the diagnosis and healing rate of periampullary diseases.Materials and Methods43 patients suspected with periampullary diseases were reviewed. All patients underwent routine MRI which include axial T1WI/T2WI and FS-T1WI/T2WI,coronal FIESTA and 2D or 3D hypotonic-MRCP scanning, 37 patients of them underwent Propeller LAVA multi-phase dynamic enhanced scan further. Reformat the original images through MIP and MPR, then draw the time-signal curve. Observe the direct and indirect signs, diagnose the genesis,nature,size and circumscription of the diseases then compared with the clinical and histopathology results. Compare the Propeller LAVA dynamic enhanced scan results to the pre-contrast MRI, use nonparametric rank sum test statistics, while P<0.05 consider it has statistical significance.Results1. For calculus,inflammation and tumor, the sensitivity and specificity of hypotonic- MRCP combine with Propeller LAVA multi-phase dynamic enhanced scan were 100% and 100%,60% and 97.4%,96.7% and 76.9%, the preoperative qualitative accuracy was 100%,93.0% and 90.6%.2. Of all the 30 tumors, 8 carcinomas of ampulla,5 cholangiocarcinomas,12 carcinomas of head of pancreas were diagnosed clearly, the accuracy rating of the tissue origin was 93.3% (28/30 ),90.0% (27/30),86.7% (26/30) .3. 37 cases underwent Propeller LAVA multi-phase dynamic enhanced scan, the direct sign display rate was 89.2% (33/37), tumor extension diagnose accordance rate was 83.3% (25/30) .The preoperative resection rate of pancreatic carcinoma,cholangiocarcinoma and carcinoma of ampulla were 76.9% (10/13),85.7% (6/7) and 88.9% (8/9) .4. For the 30 tumor cases, 25 cases were demonstrated clearly by Propeller LAVA multi-phase dynamic enhanced sequence while 2 cases by pre-contrast MRI, there was significant difference of demonstration ability between Propeller LAVA sequence and pre-contrast MRI (P<0.05) .5. As the time-signal curves display cholangiocarcinomas usually achieve the peak value at 40 to50 second, it is not definite for the carcinoma of ampulla which can at the arterial phase or lag period, the enhancement of pancreatic carcinoma is inferior to and later than the two formers .ConclusionHypotonic-MRCP combine with Propeller LAVA multi-phase dynamic enhanced scan can display the direct and indirect sign directly and fully, and have significance in identifying the circumscription of the tumor and its extension, they also have important diagnostic value in smaller periampullary diseases.