Becker C D, Grossholz M, Mentha G, de Peyer R, Terrier F
Department of Radiology, Division of Diagnostic and Interventional Radiology, University Hospital of Geneva, CH-1211 Geneva, Switzerland.
Eur Radiol. 1997;7(6):865-74. doi: 10.1007/s003300050220.
The objective of this article is to review technical aspects, discuss potential clinical indications for MR cholangiopancreatography (MRCP) and demonstrate the spectrum of diagnostic findings in benign, postoperative, and malignant conditions. We describe our current imaging protocol in comparison with other available techniques. Using a non-breath-hold, heavily T2-weighted fast-spin-echo (FSE) sequence with or without respiratory gating we obtained coronal and axial source images and maximum intensity projections (MIPs) in 102 patients with suspected abnormalities of the biliary or pancreatic ducts. Based on this series we demonstrate the diagnostic appearance of a variety of benign, postoperative, and malignant conditions of the biliary and pancreatic ducts and discuss potential clinical indications for MRCP. The non-breath-hold FSE technique enables a consistent image quality even in patients who cannot cooperate well. Respiratory gating increased the rate of diagnostic examinations from 79 to 95 %. Acquisition of coronal and axial source images enables detection of bile duct stones as small as 2 mm, although calculi that are impacted and not surrounded by hyperintense bile may sometimes be difficult to detect. The MIP reconstructions help to determine the level of obstruction in malignant jaundice, delineate anatomical variants and malformations, and to diagnose inflammatory conditions, e. g., sclerosing cholangitis, the Mirizzi syndrome and inflammatory changes in the main pancreatic duct. The MRCP technique also correctly demonstrates the morphology of bilio-enteric or bilio-biliary anastomoses. Because MRCP provides sufficient diagnostic information in a wide range of benign and malignant biliary and pancreatic disorders, it could obviate diagnostic endoscopic retrograde cholangiopancreatography (ERCP) in many clinical settings. The ERCP technique may be increasingly reserved for patients in whom nonsurgical interventional procedures are anticipated.
本文的目的是回顾技术方面，讨论磁共振胰胆管造影（MRCP）的潜在临床适应症，并展示良性、术后及恶性疾病的诊断结果范围。我们将描述我们目前的成像方案，并与其他可用技术进行比较。使用非屏气、重T2加权快速自旋回波（FSE）序列，无论有无呼吸门控，我们对102例怀疑有胆管或胰管异常的患者获得了冠状位和轴位源图像以及最大强度投影（MIP）。基于该系列，我们展示了胆管和胰管各种良性、术后及恶性疾病的诊断表现，并讨论了MRCP的潜在临床适应症。非屏气FSE技术即使在不能很好配合的患者中也能获得一致的图像质量。呼吸门控将诊断检查的成功率从79%提高到了95%。获取冠状位和轴位源图像能够检测到小至2mm的胆管结石，尽管嵌顿且未被高信号胆汁包绕的结石有时可能难以检测到。MIP重建有助于确定恶性黄疸的梗阻水平，描绘解剖变异和畸形，并诊断炎症性疾病，如硬化性胆管炎、Mirizzi综合征和主胰管的炎症改变。MRCP技术还能正确显示胆肠或胆胆吻合口的形态。由于MRCP在广泛的良性和恶性胆管及胰腺疾病中提供了足够的诊断信息，在许多临床情况下它可以避免诊断性内镜逆行胰胆管造影（ERCP）。ERCP技术可能越来越多地仅用于预期需要进行非手术介入操作的患者。
