Pavone P, Laghi A, Panebianco V, Catalano C, Passariello R
Istituto di Radiologia II Cattedra, Università degli Studi La Sapienza, Roma.
Radiol Med. 1997 Dec;94(6):632-41.
MR cholangiopancreatography (MRCP) is a new noninvasive imaging technique for the study of biliopancreatic disorders, providing projectional images of the biliary tree and pancreatic duct without any contrast agent.
We used different sequences, with both breath-hold and nonbreath-hold techniques, to acquire MRCP images, first based on GE and then on FSE sequences. FSE images provide higher SNR and are less susceptible to artifacts (metal objects, motion and blood flow artifacts). At the Department of Radiology of the University of Rome La Sapienza, we acquired MRCP images with non breath-hold, 3D fat-suppressed TSE sequences (TR = 3000-2000, TE 700, turbo factor 128) optimized on a .5T magnet with 15 mT/m gradients. No patient preparation or sedation was required, although antiperistaltic drugs and oral administration of tap water were preferred. Four hundred and thirty patients were examined, all of them with an indication to conventional cholangiography.
MRCP depicted the whole common bile duct and the first-order intrahepatic branches in all the normal cases. Its accuracy in identifying biliary obstruction level and site was 100%, versus 94.6% in characterizing its cause. MRCP had 96.3% diagnostic accuracy in choledocholithiasis, with some false positives and false negatives caused by: 1) small stones missed on MIP reconstructions; 2) signal loss due to complete CBD obstruction by stones; 3) pneumobilia; 4) differential diagnosis between small stones and air bubbles. The main role of MRCP in benign strictures is to provide a detailed map of the biliary tract for better treatment planning. In particular, MRCP is extremely useful in hepaticojejunostomy patients, where ERC is not indicated because of postoperative anatomical changes. Both conventional MRI and MRCP are important in malignant strictures to identify the lesion and to characterize and stage it. Finally, MR pancreatography is very useful to follow up chronic pancreatitis patients because it shows Wirsung duct strictures and dilatations, intraductal filling defects and, in some cases, the communication between the pseudocyst and the pancreatic duct.
MRCP combined with conventional MRI can completely replace CT and ERCP in bilio-pancreatic disorders.
磁共振胰胆管造影（MRCP）是一种用于研究胆胰疾病的新型无创成像技术，无需使用任何造影剂即可提供胆管树和胰管的投影图像。
我们使用不同的序列，包括屏气和非屏气技术来获取MRCP图像，首先基于GE序列，然后基于FSE序列。FSE图像具有更高的信噪比，并且对伪影（金属物体、运动和血流伪影）的敏感性较低。在罗马第一大学放射科，我们使用非屏气的3D脂肪抑制TSE序列（TR = 3000 - 2000，TE 700，turbo因子128）在一台0.5T磁体上、15 mT/m梯度条件下优化后获取MRCP图像。尽管使用抗蠕动药物和口服自来水更佳，但无需对患者进行特殊准备或镇静。共检查了430例患者，所有患者均有进行传统胆管造影的指征。
MRCP在所有正常病例中均能显示整个胆总管及一级肝内分支。其在确定胆道梗阻水平和部位方面的准确率为100%，而在明确梗阻原因方面的准确率为94.6%。MRCP在胆总管结石诊断中的准确率为96.3%，存在一些假阳性和假阴性结果，原因如下：1）MIP重建时遗漏小结石；2）结石完全阻塞胆总管导致信号丢失；3）胆道积气；4）小结石与气泡的鉴别诊断。MRCP在良性狭窄中的主要作用是提供详细的胆道图谱以更好地进行治疗规划。特别是在肝空肠吻合术后患者中，由于术后解剖结构改变不适合进行内镜逆行胰胆管造影（ERC）时，MRCP极为有用。传统MRI和MRCP在恶性狭窄中对于识别病变、进行特征描述及分期均很重要。最后，磁共振胰管造影对于慢性胰腺炎患者的随访非常有用，因为它可以显示主胰管狭窄和扩张、导管内充盈缺损，在某些情况下还能显示假性囊肿与胰管之间的连通情况。
MRCP联合传统MRI在胆胰疾病中可完全替代CT和ERCP。
