恶性肝门部胆管梗阻：磁共振胰胆管造影表现

Malignant perihilar biliary obstruction: magnetic resonance cholangiopancreatographic findings.

作者信息

Yeh T S, Jan Y Y, Tseng J H, Chiu C T, Chen T C, Hwang T L, Chen M F

机构信息

Department of Surgery, Chang-Gung University, Taipei, Taiwan.

出版信息

Am J Gastroenterol. 2000 Feb;95(2):432-40. doi: 10.1111/j.1572-0241.2000.01763.x.

DOI:10.1111/j.1572-0241.2000.01763.x

PMID:10685746

Abstract

OBJECTIVE

We studied the efficacy of magnetic resonance cholangiopancreatography (MRCP) in the evaluation of malignant perihilar biliary obstructions, with reference to endoscopic retrograde cholangiopancreatography (ERCP).

METHODS

A total of 40 patients with malignant perihilar biliary obstructions, who underwent both MRCP (Magnetom Vision; Siemens, Erlangen, Germany; projection technique and multislice plus maximum intensity projection) and ERCP examinations, were studied. The study group included hilar cholangiocarcinoma (Klatskin tumor) in 26 patients, icteric hepatocellular carcinoma in four patients, gallbladder carcinoma in five patients, and metastasis from other than hepatobiliary origin in five patients. Axial and coronal magnetic resonance (MR) images were added simultaneously to the MRCP. The mean serum bilirubin level on admission was 11.5 mg/ml (range, 2.8-28.5 mg/ml). The presence and extent of malignant biliary obstruction were determined with both MRCP and ERCP following the known criteria: an abrupt and irregular character of a distal narrow segment, a proportionally dilated biliary tree proximally, and an irregularly shaped intraluminal filling defect. The efficacy of the MRCP examination in detecting the presence of biliary obstruction, its anatomical extent, and the underlying cause, respectively, was compared to that of ERCP.

RESULTS

MRCP examination was successfully performed on all patients, whereas ERCP examination was unsuccessful in two patients. Both MRCP and ERCP were very effective in detecting the presence of biliary obstructions (40 of 40 vs. 38 of 38, p = 1.0). MRCP was superior in its investigation of anatomical extent (34 of 40 vs. 24 of 38, p = 0.015) and the cause of the jaundice (31 of 40 vs. 22 of 38, p = 0.023) compared to ERCP. Specifically, the performance of MRCP is promising for the interpretation of cholangiocarcinoma (22 of 26) and gallbladder carcinoma (five of five), but is relatively ineffective for the interpretation of icteric HCC (two of four) and metastasis (two of five).

CONCLUSION

MRCP represented an ideal noninvasive diagnostic tool for the evaluation of malignant perihilar biliary obstructions with reference to ERCP.

摘要

目的

我们参照内镜逆行胰胆管造影术（ERCP），研究磁共振胰胆管造影术（MRCP）在评估肝门部恶性胆管梗阻中的疗效。

方法

对40例接受了MRCP（Magnetom Vision；西门子，埃尔朗根，德国；投影技术及多层加最大强度投影）和ERCP检查的肝门部恶性胆管梗阻患者进行研究。研究组包括26例肝门部胆管癌（克氏壶腹肿瘤）、4例黄疸型肝细胞癌、5例胆囊癌以及5例非肝胆源性转移瘤患者。轴向和冠状面磁共振（MR）图像同时添加到MRCP中。入院时平均血清胆红素水平为11.5mg/ml（范围2.8 - 28.5mg/ml）。按照已知标准，通过MRCP和ERCP确定恶性胆管梗阻的存在及范围：远端狭窄段突然且不规则、近端胆管树成比例扩张以及腔内充盈缺损形状不规则。将MRCP检查在检测胆管梗阻的存在、其解剖范围及潜在病因方面的疗效分别与ERCP进行比较。

结果

所有患者均成功完成MRCP检查，而2例患者ERCP检查未成功。MRCP和ERCP在检测胆管梗阻的存在方面均非常有效（40例中的40例对38例中的38例，p = 1.0）。与ERCP相比，MRCP在解剖范围（40例中的34例对38例中的24例，p = 0.015）和黄疸病因（40例中的31例对38例中的22例，p = 0.023）的研究方面更具优势。具体而言，MRCP对胆管癌（26例中的22例）和胆囊癌（5例中的5例）的诊断表现良好，但对黄疸型肝癌（4例中的2例）和转移瘤（5例中的2例）的诊断相对无效。