低张MRI对正常十二指肠乳头及壶腹区病变的研究
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摘要
【目的】:分析低张下正常十二指肠乳头的MRI表现,为研究壶腹区病变提供重要参照;分析低张下常见壶腹区病变MR特点。
【方法】:1.正常组:选择45例志愿者,其中男性组23例,女性组22例,年龄23～78岁,平均45.7岁。MR成像设备采用GE公司1.5T SIGNA EXITE超导磁共振成像仪,对病人行SSFSE/AX,COR,FSPGR-T1WI,BH Thickslab MRCP、FIESTA/AX,COR扫描。然后肌注解痉灵20 mg,同时饮水150-200ml,5 min后依次启动上述扫描序列,行低张扫描,肌注低张药物前后病人体位及成像参数保持不变,以进行自身对照。对其MRI表现进行分析,并对解痉灵前后MR图像质量改善情况行统计学分析;2.病例组:选我院2003年10月至2007年12月MRI低张扫描诊断为壶腹区病变者35例,其中经手术病理证实16例、内镜和(或)病理证实5例、临床随访证实14例。其中男25例,女10例,年龄28～82岁,平均52.3岁。对其壶腹区病变的MRI表现进行分析。
【结果】正常组研究1.图像分析:从胃肠蠕动伪影抑制情况、十二指肠扩张度及对壶腹部解剖结构显示情况三个方面,对低张前后图像进行评价,低张后图像质量明显提高;2.丁溴东莨菪碱注射液(解痉灵)药物副作用较小;3.正常组45例中十二指肠低张效果良好的41例,十二指肠乳头显示良好的39例,十二指肠乳头的最大横径为(0.69±0.13)cm,男性组和女性组之间差异无统计学意义;4.低张后SS-FSE与FIASTA序列对十二指肠乳头的显示没有差异(P＞0.05)。病例组研究1.经经手术病理、内镜和(或)病理、临床随访证实35例病例,MRI定性诊断符合30例,准确率为85.7%;MRI定位诊断符合33例,准确率为94.3%;2.常见壶腹区病变的MR征象。
结论:1、MR低张扫描有效抑制胃肠蠕动伪影,使十二指肠充分充盈,提高壶腹部解剖结构显示,提高MRCP及MRI图像质量;2、解痉灵低张效果好,且毒副作用较低,可以作为MR低张扫描较理想的低张药物;3、正常壶腹部低张MRI表现为十二指肠扩张良好,十二指肠乳头显示清楚,正常十二指肠乳头可分为半圆型、乳头型和扁平型。十二指肠乳头的最大横径为(0.69±0.13)cm;4、SS-FSE与FIESTA序列对十二指肠乳头都有较好的显示,均可作为胆道系统的常规检查序列;5、分析低张MR后壶腹区良恶性病变的影像学特点,对诊断及其鉴别诊断壶腹区病变的具有重要临床应用价值。
[Objective] To evaluate the hypotonic MR manifestation of normal duodenal papilla to provide an important reference for diagnosing disease in ampullary portion; To analyse the hypotonic MR manifestation of the different disease in ampullary portion.
[Materials and methods] 1 Normal group 45 cases of voluntees were studied with hypotonic MRI. Male group(23 cases) and Female group (22 cases) ,ranging from 23 to 78-years-old, the average age of 45.7. MR imaging equipment is GE 1.5T SIGNA.First of all scaning SSFSE/AX, COR, FSPGR-T1WI, BH Thick slab MRCPs FIESTA/AX, COR sequence. And then,Hypotonic MR scan is startuped after 5 minute injecting scopolamine butylbromide injection(20mg) with water(150-200 ml). Before and after injecting of drugs the patients of posture and imaging parameters remain the same, to carry out self-control.Finally,analyzed MRI manifestation of normal duodenal papilla, and injecting hypotonic medicine before and after MR image quality improvements to statistical analysis; 2 clinical group 35 patients with susspect of lesions in ampullary portion were studied by hypotonic MRI scan, all cases have been surgery(16 cases), endoscopy and (or) pathology(5 cases), clinical follow-up(14 cases) confirmed. Male 25 cases,Female 10 cases ,ranging from 28 to 82-years-old, the average age of 52.3. To observe MRI manifestation of the different disease in ampullary portion.
[Results] 1 The study of normal group (1)Images analysis: Injection before and after hypotonic medicine of the image quality of MRCP and MRI were analyzed and compared from inhibition of the motion artifact by intestines,exoantion degree of duodenal and the manifestation of the ampulla demonstrating anatomy that aspect in three, result: image quality of hypotonic MR scanning was markedly improved;(2) scopolamine butylbromide injection only have smaller drug side effects;(3) Of these 45 cases, 41 were good in hypotonic effect. The longest duodenal diameter on the slice of duodenal papilla was 2.48 cm. Of these 45 cases, 39 were good in showing duodenal papilla, the longest diameter of duodenal papilla was (0.69±0.13) cm. The most diameter of duodenal papilla between male group and female group had no significant difference(P> 0. 05);(4) After injecting hypotonic medicine,there was no significant difference (P> 0.05) in showing duodenal papilla between the SS-FSE and FIASTA sequences. 2 The study of clinical group Of these 35 patients, 30 cases confirmed by surgery, endoscopy and (or) pathology, clinical follow-up accordant with MRI diagnosis of reliability of determining focus, diagnostic accordance rate is 85.7%; 33 cases confirmed accordant with MRI diagnosis of accuracy of location of focus, diagnostic accordance rate is 94.3%.
[Conclusion] 1.Hypotonic MR scan can improve effectively the quality of MRCP and MRI images;2.Scopolamine butylbromide injection is a kind of ideal hypotonic medicine,because of good hypotonic effects and lower side-effects; 3. Hypotonic MRI manifestation of normal ampulla shows duodenum is dilated moderately, and duodenal papilla could be seen clearly, and normal duodenal papilla has 3 types: semicircular, mastoid and compressed. The longest diameter of duodenal papilla was (0.69±0.13) cm;4. The SS-FSE and FIASTA sequences are good in showing duodenal papilla, their are both taked as routine scan sequences to extensive pancreaticobiliary duct diseases;5.To analyse the MRI characters of diaeases in ampullary portion afer hypotonic MR scan, and it has important clinical value of the diagnosis and differential diagnosis of different diseases in ampullary portion.
【方法】:1.正常组:选择45例志愿者,其中男性组23例,女性组22例,年龄23～78岁,平均45.7岁。MR成像设备采用GE公司1.5T SIGNA EXITE超导磁共振成像仪,对病人行SSFSE/AX,COR,FSPGR-T1WI,BH Thickslab MRCP、FIESTA/AX,COR扫描。然后肌注解痉灵20 mg,同时饮水150-200ml,5 min后依次启动上述扫描序列,行低张扫描,肌注低张药物前后病人体位及成像参数保持不变,以进行自身对照。对其MRI表现进行分析,并对解痉灵前后MR图像质量改善情况行统计学分析;2.病例组:选我院2003年10月至2007年12月MRI低张扫描诊断为壶腹区病变者35例,其中经手术病理证实16例、内镜和(或)病理证实5例、临床随访证实14例。其中男25例,女10例,年龄28～82岁,平均52.3岁。对其壶腹区病变的MRI表现进行分析。
【结果】正常组研究1.图像分析:从胃肠蠕动伪影抑制情况、十二指肠扩张度及对壶腹部解剖结构显示情况三个方面,对低张前后图像进行评价,低张后图像质量明显提高;2.丁溴东莨菪碱注射液(解痉灵)药物副作用较小;3.正常组45例中十二指肠低张效果良好的41例,十二指肠乳头显示良好的39例,十二指肠乳头的最大横径为(0.69±0.13)cm,男性组和女性组之间差异无统计学意义;4.低张后SS-FSE与FIASTA序列对十二指肠乳头的显示没有差异(P＞0.05)。病例组研究1.经经手术病理、内镜和(或)病理、临床随访证实35例病例,MRI定性诊断符合30例,准确率为85.7%;MRI定位诊断符合33例,准确率为94.3%;2.常见壶腹区病变的MR征象。
结论:1、MR低张扫描有效抑制胃肠蠕动伪影,使十二指肠充分充盈,提高壶腹部解剖结构显示,提高MRCP及MRI图像质量;2、解痉灵低张效果好,且毒副作用较低,可以作为MR低张扫描较理想的低张药物;3、正常壶腹部低张MRI表现为十二指肠扩张良好,十二指肠乳头显示清楚,正常十二指肠乳头可分为半圆型、乳头型和扁平型。十二指肠乳头的最大横径为(0.69±0.13)cm;4、SS-FSE与FIESTA序列对十二指肠乳头都有较好的显示,均可作为胆道系统的常规检查序列;5、分析低张MR后壶腹区良恶性病变的影像学特点,对诊断及其鉴别诊断壶腹区病变的具有重要临床应用价值。
[Objective] To evaluate the hypotonic MR manifestation of normal duodenal papilla to provide an important reference for diagnosing disease in ampullary portion; To analyse the hypotonic MR manifestation of the different disease in ampullary portion.
[Materials and methods] 1 Normal group 45 cases of voluntees were studied with hypotonic MRI. Male group(23 cases) and Female group (22 cases) ,ranging from 23 to 78-years-old, the average age of 45.7. MR imaging equipment is GE 1.5T SIGNA.First of all scaning SSFSE/AX, COR, FSPGR-T1WI, BH Thick slab MRCPs FIESTA/AX, COR sequence. And then,Hypotonic MR scan is startuped after 5 minute injecting scopolamine butylbromide injection(20mg) with water(150-200 ml). Before and after injecting of drugs the patients of posture and imaging parameters remain the same, to carry out self-control.Finally,analyzed MRI manifestation of normal duodenal papilla, and injecting hypotonic medicine before and after MR image quality improvements to statistical analysis; 2 clinical group 35 patients with susspect of lesions in ampullary portion were studied by hypotonic MRI scan, all cases have been surgery(16 cases), endoscopy and (or) pathology(5 cases), clinical follow-up(14 cases) confirmed. Male 25 cases,Female 10 cases ,ranging from 28 to 82-years-old, the average age of 52.3. To observe MRI manifestation of the different disease in ampullary portion.
[Results] 1 The study of normal group (1)Images analysis: Injection before and after hypotonic medicine of the image quality of MRCP and MRI were analyzed and compared from inhibition of the motion artifact by intestines,exoantion degree of duodenal and the manifestation of the ampulla demonstrating anatomy that aspect in three, result: image quality of hypotonic MR scanning was markedly improved;(2) scopolamine butylbromide injection only have smaller drug side effects;(3) Of these 45 cases, 41 were good in hypotonic effect. The longest duodenal diameter on the slice of duodenal papilla was 2.48 cm. Of these 45 cases, 39 were good in showing duodenal papilla, the longest diameter of duodenal papilla was (0.69±0.13) cm. The most diameter of duodenal papilla between male group and female group had no significant difference(P> 0. 05);(4) After injecting hypotonic medicine,there was no significant difference (P> 0.05) in showing duodenal papilla between the SS-FSE and FIASTA sequences. 2 The study of clinical group Of these 35 patients, 30 cases confirmed by surgery, endoscopy and (or) pathology, clinical follow-up accordant with MRI diagnosis of reliability of determining focus, diagnostic accordance rate is 85.7%; 33 cases confirmed accordant with MRI diagnosis of accuracy of location of focus, diagnostic accordance rate is 94.3%.
[Conclusion] 1.Hypotonic MR scan can improve effectively the quality of MRCP and MRI images;2.Scopolamine butylbromide injection is a kind of ideal hypotonic medicine,because of good hypotonic effects and lower side-effects; 3. Hypotonic MRI manifestation of normal ampulla shows duodenum is dilated moderately, and duodenal papilla could be seen clearly, and normal duodenal papilla has 3 types: semicircular, mastoid and compressed. The longest diameter of duodenal papilla was (0.69±0.13) cm;4. The SS-FSE and FIASTA sequences are good in showing duodenal papilla, their are both taked as routine scan sequences to extensive pancreaticobiliary duct diseases;5.To analyse the MRI characters of diaeases in ampullary portion afer hypotonic MR scan, and it has important clinical value of the diagnosis and differential diagnosis of different diseases in ampullary portion.
引文
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