Hosoki T, Hasuike Y, Takeda Y, Michita T, Watanabe Y, Sakamori R, Tokuda Y, Yutani K, Sai C, Mitomo M
Department of Radiology, Osaka National Hospital, Hoenzaka, Chuo-ku, Osaka, Japan.
Acta Radiol. 2004 Jul;45(4):375-82. doi: 10.1080/02841850410005462.
To assess the utility of secretin-stimulated dynamic MR cholangiopancreatography (MRCP) for the visualization of pancreaticobiliary reflux in patients with anomalous pancreaticobiliary junction (PBJ).
Ten controls and seven patients diagnosed as having anomalous PBJ were prospectively examined by dynamic MRCP after secretin injection using a breath-hold, single-shot turbo spin-echo T2-weighted sequence. The optimal MRCP section was repeated 35 times at approx. 10-second interval after secretin injection; the acquisition time was 4 s per image. The signal intensity (SI) changes of the extrahepatic and intrahepatic bile ducts, presence or absence of intraluminal signal void, caliber change of the bile duct, duodenal filling, and peak time of the SI ratio of the extrahepatic bile duct after secretin injection were compared between the controls and patients.
In the controls, the extrahepatic and intrahepatic bile ducts showed neither enhancement nor caliber change over the observation period, providing no apparent peak time. Of the seven patients, the extrahepatic bile duct showed retrograde enhancement and sequential delay in occurrence of the peak time from its distal third to its proximal third (n = 6) with a signal void in its distal part (n =4); its caliber increased subsequently to pancreatic secretion (n = 5); the intrahepatic bile ducts showed a slight enhancement following SI increase of the proximal extrahepatic bile duct (n = 6); duodenal filling grade tended to be lower in the patients than volunteers (P<.005).
In patients with anomalous PBJ pancreaticobiliary reflux were demonstrated by dynamic secretin-stimulated MRCP.
评估促胰液素刺激下的动态磁共振胰胆管造影（MRCP）对胰胆管汇合异常（PBJ）患者胰胆管反流可视化的效用。
对10名对照者和7名诊断为PBJ异常的患者，在注射促胰液素后采用屏气单次激发快速自旋回波T2加权序列进行动态MRCP前瞻性检查。在注射促胰液素后以约10秒的间隔重复采集35次最佳MRCP图像；每次图像采集时间为4秒。比较对照者和患者肝外及肝内胆管的信号强度（SI）变化、管腔内有无信号缺失、胆管管径变化、十二指肠充盈情况以及注射促胰液素后肝外胆管SI比值的峰值时间。
在对照者中，观察期间肝外和肝内胆管既无强化也无管径变化，未出现明显的峰值时间。7例患者中，6例肝外胆管出现逆行强化，峰值时间从远端三分之一处至近端三分之一处依次延迟，4例远端部分有信号缺失；5例其管径随后因胰液分泌而增宽；6例肝内胆管在近端肝外胆管SI升高后出现轻微强化；患者十二指肠充盈程度往往低于志愿者（P<0.005）。
在胰胆管汇合异常的患者中，动态促胰液素刺激MRCP可显示胰胆管反流。
