磁共振胰胆管成像（MRCP）对十二指肠乳头旁憩室的诊断价值

发布时间：2018-06-19 16:49

本文选题：十二指肠乳头旁憩室 + 磁共振胰胆管成像　；参考：《郑州大学》2014年硕士论文

【摘要】：研究背景与目的磁共振胰胆管成像（MRCP）是一种无需使用对比剂即可呈现胰胆管结构的成像技术，自从上个世纪90年代Wallner等[1]率先使用磁共振设备成功获得胰胆管水成像以来，随着技术的不断发展更新已经日趋成熟。由于MRCP的无创性，操作安全简便，无辐射等优点，最主要的是与常规有创性的成像技术如ERCP、PTC等在诊断准确性方面可相媲美，使其在胆胰系统疾病的诊断中得以广泛开展。MRCP使用重T2加权技术，使T2弛豫时间较长呈高信号的胆胰管、胃及十二指肠等含液体的器官清晰显示，并与周围组织形成鲜明的对比。十二指肠乳头旁憩室（PAD）是指位于十二指肠乳头2~3cm范围内的憩室，由于其解剖位置与胆胰管关系的特殊性，有时也会造成胆胰系统疾病，临床上称为乳头旁综合征(Lemmel’s syndrome)。由于PAD常合并胆胰系统疾病，并且许多研究证实PAD与胆总管结石、胰腺炎的发生相关[2-6]。但是由于十二指肠乳头旁憩室表现缺乏特异性，未受到临床重视，易造成误诊、漏诊，它的诊断主要依靠胃肠道造影、ERCP等影像检查技术，，随着MRCP临床应用的不断增多，发现乳头旁憩室的病例也在增加。本研究的目的是总结十二指肠乳头旁憩室在MRCP、MRI图像中的特征性表现；根据MRCP上显示的十二指肠乳头旁憩室与胆胰管的关系，探讨MRCP对十二指肠乳头旁憩室以及其与胆胰系统疾病关系的诊断价值。材料方法搜集2010年1月—2013年9月，在郑州大学第二附属医院MRI室检查，经过EPCP证实的45例PAD患者的MRCP影像资料及临床资料，其中男21例，女24例，平均年龄为71岁。回顾性分析这45例患者的影像资料。所有病例均采用3D-MRCP序列，轴位脂肪抑制T2WI序列，屏气冠状位脂肪抑制FIESTA序列，屏气轴位以及冠状位LAVA三期增强序列扫描。图像经过MIP后处理后由两名高年资的诊断医师独立阅片，达成共识后，进行诊断及鉴别诊断。通过PAD在MRCP、MRI上的影像表现，总结其信号特征、位置以及测量憩室的直径等。对PAD合并的胆胰系统疾病的例数进行分类，分别统计PAD直径、位置与有无合并胆总管结石的关系，应用SPSS17.0软件进行统计学分析。结果 45例PAD，2例为多发憩室，共47个。MRCP表现为十二指肠降段内侧的囊袋状影，29个（61.8%）可见PAD颈部与十二指肠粘膜相连续；轴位脂肪抑制T2WI序列中表现为十二指肠内侧胰头右后方的囊状影，边界清楚，可见部分被胰头钩突包埋，与胰头交界处边缘锐利，清晰，26个PAD（55.3%）可见气液平面。LAVA三期增强扫描憩室内未见强化，憩室壁薄光滑，同肠粘膜信号。经过MIP后处理的MRCP图像上PAD的显示率为65.9%(31/47)，MIP后处理MRCP图像+原始薄层MRCP图像+轴位T2WI序列对PAD的显示率达95.6%(45/47),两者相比差异有显著统计学意义（P0.05）。 PAD合并胆胰系统疾病的发病率为80%（36/45），其中胆总管结石为44.4%（20/45）。合并胆总管结石的PAD有较大的直径，与未合并胆总管结石的PAD直径相比，差异有统计学意义（P0.05）。周围型和水平型憩室与有无伴发胆总管结石无显著性差异（P0.05）。结论 1、十二指肠乳头旁憩室在MRCP图像中有比较典型的特征性表现，MRCP对十二指肠乳头旁憩室的定位和定性诊断都较准确，3D-MRCP与轴位T2WI序列相结合可作为诊断十二指肠乳头旁憩室的优先选择序列。MRCP结合MRI平扫及增强扫描对胆胰系统疾病做出及时诊断的同时，提示憩室与胆胰系统疾病的相关性，为临床明确病因、诊断和治疗提供帮助。 2、十二指肠乳头旁憩室的大小与胆总管结石的形成可能存在一定的相关性。
[Abstract]:Research background and purpose
Magnetic resonance cholangiopancreatography (MRCP) is an imaging technique that can present the structure of the pancreatic bile duct without using a contrast agent. Since Wallner and other [1] took the lead in obtaining the cholangiopancreatography after the first use of MRI equipment in the last century in 90s, it has become more and more mature with the continuous development of technology. The operation is safe and simple because of the noninvasive of MRCP. With the advantages of no radiation, the most important thing is to compare with the conventional and invasive imaging techniques such as ERCP, PTC and so on, which can be used in the diagnosis of biliary and pancreatic diseases by.MRCP using heavy T2 weighted technique, the T2 relaxation time is high in the high signal bile duct, and the organs containing liquid in the stomach and duodenum are clear. It shows and contrasts with the surrounding tissue. The duodenal papillary diverticulum (PAD) refers to the diverticulum located in the 2~3cm of the duodenum papilla. Because of its anatomical location and the particularity of the relationship between the bile duct and the pancreatic duct, the duodenal nipple diverticulum sometimes causes the disease of the biliary and pancreatic system, which is called the Lemmel 's syndrome in clinical. Because PAD often combines the bile. Pancreatic diseases, and many studies have confirmed that PAD is associated with choledocholithiasis and the occurrence of [2-6]., but the lack of specificity of the papillary diverticulum of the duodenum is lacking, and it is not subject to clinical attention. It is easy to cause misdiagnosis and missed diagnosis. Its diagnosis mainly depends on gastrointestinal imaging, ERCP and other imaging techniques, with the increasing clinical application of MRCP. Many cases of papillary diverticulum have also been found to be increasing.
The purpose of this study was to summarize the characteristics of the duodenal para papillary diverticulum in MRCP and MRI images, and to explore the diagnostic value of MRCP on the para papillary diverticulum and its relationship with the biliary and pancreatic diseases according to the relationship between the para papillary diverticulum and the biliary pancreatic duct on MRCP.
Material method
From January 2010 to September 2013, the MRCP imaging data and clinical data of 45 patients with PAD confirmed by EPCP in the MRI room of the Second Affiliated Hospital of Zhengzhou University were examined, including 21 males and 24 females, with an average age of 71 years. The imaging data of these 45 patients were analyzed retrospectively. All the cases were 3D-MRCP sequence and axial fat suppression T2WI sequence. The FIESTA sequences, the breath holding axis and the coronal LAVA three phase enhanced sequence scan were held. After MIP post-processing, the images were read independently by two senior medical doctors, and the diagnosis and differential diagnosis were made after the consensus was reached. The signal characteristics, location and measurement diverticulum were summarized by the image of PAD on MRCP and MRI. The number of cases of biliary and pancreatic diseases combined with PAD were classified, and the relationship between PAD diameter, location and choledocholithiasis without combined choledocholithiasis was statistically analyzed, and SPSS17.0 software was used for statistical analysis.
Result
45 cases of PAD, 2 cases of multiple diverticulum, a total of 47.MRCP manifestations of the internal capsule of the duodenum descending segment, 29 (61.8%) visible PAD neck and duodenal mucosa continuous, the axial fat suppression T2WI sequence is manifested as the right posterior duodenal pancreatic head of the cystic shadow, the boundary is clear, visible part of the pancreatic head uncinate burial, and the junction of the head of the pancreas The edge was sharp and clear. 26 PAD (55.3%) visible air and liquid plane.LAVA three enhanced scanning diverticulum was not strengthened, the wall of the diverticulum was thin and smooth, with the signal of intestinal mucosa. The display rate of PAD on the MRCP image after MIP was 65.9% (31/47), and MRCP image + original thin layer MRCP image + axial T2WI sequence to PAD was 95.6% (45/47). There was a significant difference between the two groups (P0.05).
The incidence of PAD with choledochic and pancreatic diseases was 80% (36/45), of which choledocholithiasis was 44.4% (20/45). The PAD with choledocholithiasis had a larger diameter. The difference was statistically significant compared with the PAD diameter without common bile duct stones (P0.05). There was no significant difference between the peripheral and horizontal diverticulum and the common bile duct stones (P0.05).
conclusion
1, the papillary diverticulum of the duodenum has a typical characteristic in the MRCP image. MRCP is more accurate for the location and qualitative diagnosis of the duodenal paravillum diverticulum. The combination of 3D-MRCP and axial T2WI sequence can be used as a priority selection sequence for the diagnosis of duodenal papilla diverticulum by.MRCP combined with MRI scan and enhanced scan for the biliary and pancreatic systems. When the disease is diagnosed in time, it suggests the correlation between diverticulum and diseases of biliary and pancreatic system, so as to provide help for clinical diagnosis, diagnosis and treatment.
2, the size of the peripapillary diverticulum may be related to the formation of common bile duct stones.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.2;R574.51

【参考文献】