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目的探讨高浓度钆塞酸二钠短T_2效应对T_2WI和磁共振胰胆管造影(MRCP)显示胆道系统解剖结构以及结石的影响。方法 66例肝硬化患者,Child-Pugh(CP)分级A级33例,B级24例,C级9例,行MRI钆塞酸二钠增强前及肝胆期10、15和20 min轴位SSFSE T_2WI和MRCP检查,记录对比剂在肝管、胆总管以及胆囊在T_2WI、MRCP上出现时间以及表现,分析其对胆道结构和病变显示影响。结果对比剂引起T_2WI上胆管信号降低(n=62),胆汁和对比剂分层(n=21),形成点状“充盈缺损”(n=6),在较宽大的胆管内对比剂形成浮云状低信号(n=2)。低信号的对比剂沿胆囊内侧壁充盈,在胆囊底部似充盈缺损(n=35),浮云状低信号(n=18),线样低信号沿胆囊长轴直达胆囊底部(n=1)。在T_2WI上肝胆期肝外胆道各部分显影程度和时间与CP分级相关(肝管延迟10 min r=-0.393,P=0.001;胆总管延迟10 min r=-0.416,P=0.001,延迟15 min r=-0.485,P<0.001;胆囊延迟10 min r=-0.365,P=0.004,15 min r=-0.329,P<0.001,延迟20 min r=-0.483,P=0.011),在MRCP上胆管显影也与CP分级相关(延迟10 min r=-0.555,P<0.001,20 min r=-0.372,P=0.002)。3例胆囊结石和1例肾盂结石与对比剂难以区分。结论钆塞酸二钠短T_2效应影响胆道解剖结构在T_2WI和MRCP上显示,而且与肝硬化程度相关,与胆道结石难以区分,建议这些序列安排在增强前进行。
Objective To investigate the effects of high concentration of disodium T-gadolinium disodium on T 2 WI and MRCP in the biliary system anatomy and calculi. Methods Sixty-six patients with cirrhosis were divided into three groups: Child Grade A (33 cases), Child B Pugh (Group C), Grade B (24 cases) and Grade C T_2WI and MRCP were performed to record the time and performance of the contrast agent in the T 2 WI and MRCP of the hepatic duct, common bile duct and gallbladder. The effect of contrast agent on biliary structure and lesions was analyzed. RESULTS: Contrast agents caused a decrease in bile duct signals (n = 62) on T2WI, stratified bile and contrast media (n = 21), forming a punctate defect filling (n = 6) A cloud-like low signal is formed (n = 2). Low-contrast contrast media filled the medial gallbladder, filling the gallbladder at the bottom (n = 35), cloud-like low signal (n = 18) and linear low signal reaching the gallbladder at the base of the gallbladder (n = 1). The extent and timing of extrahepatic extrahepatic biliary development on the T2WI were correlated with CP grade (delayed hepatic duct 10 min r = -0.393, P = 0.001; delayed common bile duct 10 min r = -0.416, P = 0.001, delayed 15 min r = -0.485, P <0.001; gallbladder delayed 10 min r = -0.365, P = 0.004, 15 min r = -0.329, P <0.001, delayed 20 min r = -0.483, P = 0.011) Development was also associated with CP classification (10 min r = -0.555 delay, P <0.001, 20 min r = -0.372, P = 0.002). Three cases of gallstone and one case of pelvis and contrast agent difficult to distinguish. Conclusions The short T 2 effect of disodium gadoxate affects the biliary anatomy displayed on T 2 WI and MRCP, and is related to the degree of liver cirrhosis, which is indistinguishable from biliary stones. It is suggested that these sequences should be arranged before enhancement.