Hänninen E L, Pech M, Jonas S, Ricke J, Thelen A, Langrehr J, Hintze R, Röttgen R, Denecke T, Winter L, Neuhaus P, Felix R
Department of Radiology, Charité Medical University Center, Campus Virchow Clinic, Berlin, Germany.
Acta Radiol. 2005 Aug;46(5):462-70. doi: 10.1080/02841850510021625.
To assess image quality and overall accuracy of magnetic resonance imaging (MRI), including two magnetic cholangiopancreatography (MRCP) techniques, for the diagnostics and preoperative work-up of malignant hilar obstructions.
Thirty-one patients with malignant hilar obstructions (hilar cholangiocarcinoma, n=30; hepatocellular carcinoma, n=1) received MRCP by two techniques (single-shot thick-slab and multisection thin-slice MRCP) and unenhanced and contrast material-enhanced MRI. MR assessment included the evaluation of image quality and visualization of bile ducts (5-point scale), and the classification of tumor status. MR results were subsequently correlated with the results from surgery and pathology.
The maximum intensity projections of multisection thin-slice MRCP had significantly more artifacts compared to MRCP in the single-shot thick-slab technique, and overall image quality of single-shot thick-slab MRCP was rated significantly superior compared to multisection thin-slice MRCP (4.4 +/- 0.7 and 4.1 +/- 0.9, respectively). Moreover, ductal visualization of different parts of the biliary system was rated superior with single-shot thick-slab MRCP. In contrast, the original data from multisection thin slice MRCP facilitated visualization of periductal lesions and adjacent structures. Overall MR accuracy for the assessment of tumor status, periductal infiltration, and lymph node metastases was 90%, 87%, and 66%, respectively.
For evaluation of malignant hilar obstructions, MRCP by the single-shot thick-slab technique had superior image quality and fewer artifacts; in contrast, besides sole biliary visualization, multisection MRCP depicted complementary adjacent parenchymal and periductal structures. We therefore recommend MRI, with a combination of both MRCP techniques, for the diagnostic work-up and therapy planning of malignant hilar obstructions.
评估磁共振成像（MRI），包括两种磁共振胰胆管造影（MRCP）技术，用于恶性肝门梗阻的诊断和术前检查的图像质量及总体准确性。
31例恶性肝门梗阻患者（肝门胆管癌，n = 30；肝细胞癌，n = 1）接受了两种技术的MRCP检查（单次激发厚层 slab和多层面薄层MRCP）以及平扫和对比剂增强MRI检查。MR评估包括图像质量评估、胆管可视化（5分制）以及肿瘤状态分类。随后将MR结果与手术和病理结果进行相关性分析。
与单次激发厚层 slab技术的MRCP相比，多层面薄层MRCP的最大强度投影有明显更多的伪影，并且单次激发厚层 slab MRCP的总体图像质量评分明显优于多层面薄层MRCP（分别为4.4±0.7和4.1±0.9）。此外，单次激发厚层 slab MRCP对胆道系统不同部位的导管可视化评分更高。相比之下，多层面薄层MRCP的原始数据有助于观察导管周围病变和相邻结构。评估肿瘤状态、导管周围浸润和淋巴结转移的总体MR准确性分别为90%、87%和66%。
对于评估恶性肝门梗阻，单次激发厚层 slab技术的MRCP具有更好的图像质量和更少的伪影；相比之下，除了单纯的胆道可视化外，多层面MRCP还能显示相邻的实质和导管周围结构作为补充。因此，我们建议将MRI与两种MRCP技术结合用于恶性肝门梗阻的诊断检查和治疗规划。
