Mri Diagnosis Of Pancreaticobiliary Ductal And Duodenal Union Diseases

Objectives:To study the anatomy of ampulla region by MRCP for application; to discuss the value of hypotonic-MRCP combined with LAVA dynamic enhanced scanning in the diagnosis of pancreaticobiliary ductal and duodenal union diseases.Methods:1. MRCP was performed in 42 volunteers ranged from 2008-8-1 to 2009-1-1.The ampulla region of 42 volunteers would be mearured by many points.2. 30 volunteers underwent conventional MRCP and hypotonic-MRCP, and they were evaluated by four points.3. 113 patients examined by MRCP ranged from 2008-1-1~2009-3-1, were divided into two parts: one was'the patients'with acute pancreatitis, another was'the controls'without it. The two parts were compared by four aspects: the type of choledochopancreatic junction, variant pancreatic duct, the angle formed by common bile duct and pancreatic duct and the length of the two ducts walking together.4. Five patients with duodenal tumor underwent MRI examination after duodenum was in hypotonicity, and then examined with hypotonic-MRCP and LAVA dynamic enhancement scanning.5. 32 patients with pancreaticobiliary ductal and duodenal union disease underwent MRI examination after duodenum was in hypotonicity, and then examined with hypotonic-MRCP and LAVA dynamic enhancement scanning.Results:1. The choledochopancreatic junctions could be classified into three kinds:"Y"modes were 71.4%(30/42),"V"modes were 16.7%(7/42),"U"modes were 11.9%(5/42). And there were great individual differents in some mearurements.The rate of occurrence of duodenal papilla was 19.0%(8/42),most of wich were hemicyle.2. Hypotonic-MRCP could inhibit gastric motility artifacts, fill duodenal intestine. Pancreaticobiliary ductal and duodenal union and its surrounding organs showed more clearly than before.3. The two parts had statistical significance in three aspects: the angle formed by common bile duct and pancreatic duct, the length of the two ducts walking together and variant pancreatic duct.4. All of 5 cases were duodenal adenocarcinoma confirmed by pathologic diagnosis, 4 of 5 cases were correctly diagnosed. The common signs were: The cavum of descending duodenum was asymmetrical stenosis, where we could find the signal of soft tissue connecting the intestinal wall with wide base. Being adjacent to the lesion, the intestinal wall was stiff, the intestinal mucosa was destructive. And the lesion would be slightly-moderately enhanced in LAVA dynamic enhancement scanning. 5. In the 32 cases, 12 cases were calculus, 8 cases were pancreatic-head carcinoma, 5 cases were duodenal adenocarcinoma, 2 cases were cholangiocarcinoma, 2 cases were ampullary carcinoma, 1 case was tuberculosis, 1 case was islet cell tumor.Conclusion:1. To study the anatomy of ampulla by MRCP and FIESTA is very important for differential diagnosis.2. The image quality of Hypotonic-MRCP was improved significantly, compared with conventional MRCP.3. The risk factors of acute pancreatitis are variant pancreatic duct,long length of the two ducts walking together and wide angle formed by common bile duct and pancreatic duct.4. Hypotonic-MRCP combined with LAVA dynamic enhancement scanning might display the direct and indirect sign, which was effective in identifying the circumscription of the tumor and its extension, of duodenal tumor.5. Hypotonic-MRCP combined with LAVA dynamic enhancement scanning might display the direct and indirect sign, which was effective in identifying the circumscription of the disease and its extension, of pancreaticobiliary ductal and duodenal union diseases.