Lam W W, Lam T P, Saing H, Chan F L, Chan K L
Department of Diagnostic Radiology, Queen Mary Hospital, University of Hong Kong, China.
AJR Am J Roentgenol. 1999 Aug;173(2):401-5. doi: 10.2214/ajr.173.2.10430145.
We report our experience using MR cholangiography and CT cholangiography in pediatric patients with choledochal cysts.
Fourteen patients (two boys, 12 girls; mean age, 7.8 years) with either a preoperative diagnosis of choledochal cyst or a surgical finding of choledochal cyst underwent non-breath-hold MR cholangiography using T2-weighted fat-suppressed fast spin-echo sequences with a 1.5-T magnet, and CT cholangiography with IV infusion of meglumine iodoxamic acid. Radiologic findings were correlated with findings from surgery, operative cholangiography, or percutaneous transhepatic cholangiography.
The biliary tree was visualized in all 14 patients with MR cholangiography and in 13 patients (92.9%) with CT cholangiography. In the 11 preoperative cases of choledochal cyst, MR cholangiography correctly showed all cysts and CT cholangiography showed 10 cysts (90.9%). The quality of images on CT cholangiography and MR cholangiography was comparable. The sensitivity of CT cholangiography and MR cholangiography in revealing intrahepatic stones was 83.3% and 66.7%, respectively; the specificity for both techniques was 100%. The rate of detecting the pancreatic duct and the common channel by CT cholangiography and MR cholangiography was 63.6% and 45.5% respectively. After surgery, CT cholangiography was superior to MR cholangiography in revealing the location of biliary-enteric anastomosis and the extent of anastomotic narrowing.
Because non-breath-hold MR cholangiography is not invasive and does not use ionizing radiation and potentially toxic contrast agents, it is recommended as the imaging technique of choice in children with choledochal cysts. CT cholangiography can be considered as an adjunct after surgery and in patients in whom MR cholangiography is unsatisfactory.
我们报告在患有胆总管囊肿的儿科患者中使用磁共振胰胆管造影（MR cholangiography）和CT胰胆管造影（CT cholangiography）的经验。
14例患者（2例男孩，12例女孩；平均年龄7.8岁），术前诊断为胆总管囊肿或手术发现胆总管囊肿，使用1.5-T磁体，采用T2加权脂肪抑制快速自旋回波序列进行屏气MR胰胆管造影，并静脉输注碘番酸进行CT胰胆管造影。影像学检查结果与手术、术中胆管造影或经皮肝穿刺胆管造影结果相关。
14例患者中，MR胰胆管造影均显示了胆管树，CT胰胆管造影显示了13例（92.9%）。在11例术前胆总管囊肿病例中，MR胰胆管造影正确显示了所有囊肿，CT胰胆管造影显示了10例囊肿（90.9%）。CT胰胆管造影和MR胰胆管造影的图像质量相当。CT胰胆管造影和MR胰胆管造影显示肝内结石的敏感性分别为83.3%和66.7%；两种技术的特异性均为100%。CT胰胆管造影和MR胰胆管造影检测胰管和共同通道的比率分别为63.6%和45.5%。手术后，CT胰胆管造影在显示胆肠吻合口位置和吻合口狭窄程度方面优于MR胰胆管造影。
由于屏气MR胰胆管造影是非侵入性的，不使用电离辐射和潜在有毒的造影剂，因此推荐作为胆总管囊肿患儿的首选成像技术。CT胰胆管造影可作为手术后及MR胰胆管造影不满意患者的辅助检查。
