The Study Of Orally Gd-DTPA And Drotaverine Hydrochloride Tablets Used In 3.0-Tesla MRCP And The Value Of MRCP In Diagnosis Of The Anatomic Variations Of The Internal Bile Duct And The Cystic Duct

Part I The Study of orally Gd-DTPA and Drotaverine Hydrochloride Tablets used in 3.0-Tesla MRCP1,Objective:To improve the imaging quality of cholangiopancreatic duct system in MRCP by using oral Gd-DTPA as a negative contrast agent to reduce the bowel signal intensity during MR cholangiopancreatography (MRCP), oral gastrointestinal spasmolytic medcine (Drotaverine Hydrochloride Tablets) to reduce gastrointestinal motion artiract.2,Materials and Methods:2.1 Drugs Source:Magnevist (Gd-DTPA) injection produced by the Bayer Schering Pharma Ag and Drotaverine Hydrochloride Tablets produced by the Hangzhou Sanofi Minsheng Pharmaceutical Co., Ltd.2.2 Case Selection30 healthy volunteers:18 male,12 female, aged from 25 to 65, average age 42, no biliary disease and related surgical history were included in the scope of the study. 2.3 Scanning parameters and sequences:All patients were examined with 3.0T super conduction MR scanner (Philips Archieva 3.0T) with body abdominal Phased-array coil. T1WI,T2WI sequences were performed. Then MRCP images were reconstructed to 3D directly from the source images by standard maximal intensity projection (MIP) methods.2.4 Study in vitro:Gd-DTPA of 0.5,1,2,3,4,5,6 and 7 ml were added with 99.5,99,98,97,96,95,and 94,93 ml of warm water respectivly (concentrations 0.0025,0.005,0.010,0.015,0.020,0.025,0.030 and 0.035 mol/ml). Then the different concentration group of Gd-DTPA diluted solution and the control group were performed with T1WI, T2WI,2D-FSE, and the signal intensity were measured for the different concentrations of contrast group and control group. And different concentrations of contrast agents were compared in each imaging sequence and the enhancement rate of signal intensity.2.5 Methods in vivo:30 cases of volunteers were performed conventional MRCP,oral solution diluted Magnevist (The optimal concentration of Gd-DTPA was secelected by the vitro study), oral Drotaverine Hydrochloride Tablets, oral Magnevist solution and Drotaverine Hydrochloride Tablets, then measured the singal intensity and compared the enhancement rate of liquid in the gastric corpus, antrum and duodenum descending between routine team and Magnevist team,and measured the diameter changes of left hepatic duct, right hepatic duct, hepatic duct, cystic duct, common bile duct and pancreatic duct between routing team and Drotaverine Hydrochloride Tablets team, and evaluated the image quality of anatomical structures on the MRCP.2.6 Images analysis:Two radiologists respectively in double-blind method: Comparison of TIWI,T2WI and MRCP images were analyzed2.7 Statistics analysis:Established using statistical software SPSS13.0 and statistical data for the score board. Measurement data show by x±s, and the ranked data use Nonparametric Non-parametric rank and review (Nonparametric Wilcoxon's test) to Statistical analysis. P> 0.05 for the difference was not statistically significant; P< 0.05 for the difference was statistically significant3 Results3.1 Experiments in vitro:The control group was high signal on T2 FSE sequences while low signal on T1WI. On TIWI, the signal intensity and the enhancement rate for each dilution increased with the increasing of theGd-DTPA concentration while decreased remarkably on T2WI.When the concentration reached 0.025mol/ml, the signal intensity decreased to similar background noise,. the signal strength of 6 to 8 group was 6.8,6.6 and 6.5, have similar background noise; in this imaging sequence, each set of dilution rate for both negative percentage signal enhancement, the higher the concentration, the larger negative value, such as the 6-8 group, the signal attenuation rates by 99.49%,99.51% and 99.51%, and no significant difference statistically, so we choose the dilution of group 6 (the concentration of 0.025 mol/m 1) as the best dilution to reduce the bowel signal intensity during MR cholangiopancreatography (MRCP).3.2 Test results in vivo:3.21 30 cases of volunterr were performed MRCP after oral 100ml concentration 0.025mmol/ml of Gd-DTPA solution, the signal intensity was measured separately on the MRCP imagings in the gastric corpus, antrum and duodenum. Result shows, the signal intensity was distinctly lower in the gastric corpus, antrum and duodenum after oral, in MRCP, high gastrointestinal liquid signal was basically suppressed.3.22 Compared with routine team, the diameters of the bile duct,including left,/right hepatic duct, hepatic duct, common bile duct, pancreatic duct,were increased on Drotaverine Hydrochloride Tablets team. 3.23 The group of Gd-DTPA and Drotaverine Hydrochloride Tablets got the better image quality than other three groups.4 Conclusions4.1 Gd-DTPA solution of 0.025mmol/ml can effectively suppress the high-water signal, The signal attenuation is not significant difference as the concentration is over. Therefore we chose the concentration of Gd-DTPA 0.025mmol/ml solution as the best concentration in 3.0T MRCP.4.2 Oral 100ml Gd-DTPA solution (0.025mmol/ml) in 15 minutes before the MRCP examination can basically inhibit the high signal fluid of the gastrointestinal tract, in order to display pancreatic duct much clearer.4.3 Oral 80mg Magnevis hydrochloride tablets in 1 hour before the MRCP examination can relax muscleation, display structure of pancreatic duct better (3 intrahepatic bile duct, cystic duct and pancreatic duct, etc).4.4 Oral 80mg Magnevis hydrochloride tablets and 100ml Gd-DTPA solution(0.025mmol/ml) in 1 hour and 15 minutes respectively before the MRCP examination, not only display pancreatobiliary ducts better,but also inhibit the high signal fluid of the gastrointestinal tract,, the MRCP image quality is improved significantly.Part II The value of MRCP in diagnosis of the anatomic variations of the internal bile duct and the cystic duct1 Objective:To explore the value and clinical significance of magnetic resonance cholangiopancreatography (MRCP) in diagnosing the anatomic variations of the internal bile duct and the cystic duct2 Materials and Methods:320 cases of imaging were collected and analyzed during Jan 2008 to Jul 2010,129 male,191 female, aged from 11 to 79.2.1 Scanning parameters and sequences:All patients were examined with 3.0T super conduction MR scanner (Philips Archieva) with body abdominal Phased-array coil. Three sequences, including T1WI,T2WI and 2D-FSE were performed. TR: 8000-16000ms, TE:200-252ms, FOV:24-36cm, matrix:512x192, slice thickness: 2-5mm, spacing:0mm,30-60 successive layers, encouraging twice, imaging time 4-6min.Then MRCP images were projected directly from the source images by standard maximal intensity projection (MIP) methods.2.2 Image analysisIn double-blind cases, by two experienced radiologists, deputy director of the above were marked on the MRCP images. Refer to the methods of Taoureal and Kwon and others', the variations of the cystic duct were divided into as follows:(Dcystic duct converge into the bifurcation of left and right hepatic duct;②low drain into the hepatic duct, the standard length for the hepatic duct/common bile duct length> 1;③cystic duct to bypass the pronation or supination drain into the left hepatic duct;④paralled with common hepatic duct above 2 cm;⑤short cystic duct (<5mm);⑥cystic duct dilation;⑦other special types:such as double cystic ducts, cystic duct drain into the right hepatic duct, cystic duct drain into the left or right hepatic duct and so on. According to Choi and other researchers, the branching patterns of IHDs were classified as seven types. The anatomy of type 1 was typical, i.e. acommon hepatic duct was formed by fusion of the RHD and LHD. The RHD arised through fusion of the RASD,which drains anterior segments V and VIII, and the RPSD,which drained posterior segments VI and VII. Type 2 involves triple confluence, the simultaneous emptying of theRASD, RPSD and LHD into the common hepatic duct(CHD). Type 3, representing anomalous drainage of the RPSD, was subdivided into types 3A,3B, and 3C, accordingto the drainage pattern of the RPSD. In type 3A,this drained into the LHD; in type 3B, into the CHD and in type 3C, into the cystic duct. Type4IHD systems are those in which the RHD drains into thecystic duct. Type 5, in which an accessory duct ispresent, was subdivided into types 5A and 5B according to the drainage pattern of duct:in type 5A, it drained into the CHI), and in type 5B, into the RHD. Atype 6 was one in which segments II and III of the segmentalduct drained individually into the RHD or CHD,while a type 7 showed unclassified or complex variation.3 Results:In routine MRCP examination, there were 300 cases of cystic duct showed clearly in 320 patients.29 cases of anatomic variants of cystic duct were demonstrated in 300 cases(9.7%):there ware 3 cases of cystic duct drained into the bifurcation of left and right hepatic duct,5 cases of low cystic duct drained into the common hepatic duct,4 cases of low cystic duct which paralleled with common hepatic duct drained into the common hepatic duct.5 cases of forward or backward pronated converged into the left side of the common hepatic duct,3 cases which paralleled with common hepatic duct converged into the left side of the common hepatic duct,3 cases paralleled with common hepatic duct,4 cases of cystic duct drained into the right hepatic duct,2 cases of short cystic duct.16 cases of stone in cystic duct of variation were discovered,and 13 cases no stones; In normal cases, cystic duct stones in 78 cases, no gall bladder or cystic duct stones in 193 patients. Compared the stone incidence between variation and normal group of cystic duct by x2 test, x 2=8.480, P<0.05,patients with aberrance get higher stone incidence than normal.There was significant difference.In MRCP examination,there were 312 cases showed clearly the intrahepatic bile duct anatomy in 320 patients, anatomic variants of bile duct were demonstrated in 101,.There was triple confluence type in 31 cases, typeⅢ55 cases,(typeⅢA in 32 cases, IIIB type in 17 cases, typeⅢC in 6 cases), TypeⅤin12 cases(typeⅤAin 8 cases, type V B4 cases),typeⅥin 2 cases, typeⅦ1 case. Variation in the intrahepatic bile duct in 101 cases, there were 40 cases of intrahepatic bile duct stones in 101 cases with variation:22 cases of variation of bile duct stones in itself, outside the intrahepatic bile duct stones mutation in 18 cases,61 patients without intrahepatic bile duct stones. In 211 regular-type cases of intrahepatic bile duct, it was 77 cases which got stones in intrahepatic,158 cases without stones. Compared the stones incidence between variation and normal group of intrahepatic bile by x2 test, x 2=8.480, P<0.05,patients with aberrance get higher stone rate than normal.There was significant difference.4 Conclusion:The internal and external bile calculus and the cystic calculus is basically correlation with the anatomic variations of the internal and external bile ductus and the cystic duct. MRCP is an non-invasive and speediness imaging method to show the anatomic variations of the internal and external bile ductus with the cystic duct and the stones in them.