胆囊增大的MRCP和常规MRI诊断

目的：探讨磁共振胰胆管成像（MRCP）和常规MRI对胆囊增大的诊断价值。方法：回顾性分析经腹腔镜或外科手术证实的29例胆囊增大病人的临床和影像资料。对每一例患者在术前行MRCP和常规轴面T1WI与T2WI联合检查,将影像诊断与手术所见及病理诊断结果对照,评价术前MRCP和MRI对胆囊增大病因的诊断正确率。结果：①本组增大胆囊的长径范围为8.01～18.13cm（平均11.93cm±3.20）,横径范围为4.12～7.05cm（平均4.59cm±0.91）;②29例胆囊增大的病因诊断如下：与胆道结石相关的良性病变17例（胆总管结石7例、急性与慢性胆囊炎伴胆囊结石4例、胆囊腺肌瘤病和Mirizzi综合征各3例）,低张力胆囊1例,MRCP和MRI的诊断敏感度为83.33%（15/18）,特异度为72.22%（13/18）;由肿瘤性病变引起的胆囊增大11例（胆囊癌1例、肝门胆管癌1例、胆总管癌5例及壶腹周围癌4例）,MRCP和MRI的诊断敏感度为90.90%（10/11）,特异度为81.81%（9/11）。结论：胆囊增大可由良、恶性胆囊疾病与肝外胆管梗阻性病变引起,MRCP和常规MRI联合检查有助于明确病因诊断。

Diagnosis of Gallbladder Enlargement on Magnetic Resonance Cholangiopancreatography Combined with Conventional MR Images

Objective:To investigate the diagnostic value of MRCP combined with conventional MRI in determination of the etiology of gallbladder enlargement.Methods:MRCP,conventional axial T1WI and T2WI sequences were performed in 29 patients with gallbladder enlargement.Imaging findings were analyzed retrospectively.Each pre-operative imaging diagnosis related to the etiology was correlated with findings of direct vision of laparoscopic or surgical operation,and post-operative examination of pathology.Results:1) Different degree of gallbladder enlargement was showed in each patient of the study,the longitudinal ranges of the gallbladder were from 8.01 cm to 18.13 cm(mean 11.93 cm ± 3.20),the transverse diameters ranged from 4.12 cm to 7.05 cm(mean 4.59 cm ± 0.91).2) Final etiological diagnosis was as follows:18 cases were benign lesions,they included choledocholithiasis in 7 cases,acute and chronic cholecystitis associated with cholecystolithiasis in 4 cases,gallbladder adenomyomatosis in 3 cases,Mirizzi syndrome in 3 cases and atonic gallbladder in 1 case.Diagnostic sensitivity and specificity of MRCP combined with conventional MRI were 83.33%(15/18) and 72.22%(13/18),respectively;11 cases were malignant lesions which included gallbladder cancer in 1 case,hepatic hilar cholangiocarcinoma in 1 case,common bile duct carcinoma in 5 cases and periampullary carcinoma in 4 cases.Diagnostic sensitivity and specificity of MRCP combined with conventional MRI were 90.90%(10/11) and 81.81%(9/11),respectively.Conclusion:Gallbladder enlargement might resulted from benign and malignant lesions in the gallbladder and extrahepatic bile duct,MRCP examination combined with conventional axial T1WI and T2WI were helpful in defining the etiology of diseases.