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| 单一磁共振胆胰管成像诊断肝移植术后胆道并发症 |
| 蒋涛,王俭,肖湘生,刘光华,韩希年,刘士远,王金林 |
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| (第二军医大学长征医院影像科,上海,200003) |
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| 摘要: |
| 目的:评价磁共振胆胰管成像(MRCP)作为单一影像学手段在诊断原位肝移植术后胆道并发症中的临床应用价值.方法:分析54例肝移植术后怀疑有胆道并发症患者的MRCP图像,并与手术、胆道造影、临床随访结果进行对照.所有病例均在高场强1.5T磁共振上进行.MRCP采用两种不同的成像方法:厚层块T2加权成像和薄层块多层T2加权成像.结果:54例中最终经手术、胆道造影、临床随访确实存在胆道并发症的有36例.MRCP诊断肝移植术后胆道并发症的敏感性为100﹪(36/36),阳性预测值91.7﹪(33/36),假阳性率为5.56﹪(2/36),诊断准确率为94.4﹪(51/54).MRCP作为单一的诊断方法能为96.3﹪(52/54)的患者提供特异性诊断结果,仅2例患者需要内镜下逆行性胰胆管造影术(ERCP)和经皮肝穿刺胆道造影术(PTCH)检查.直接胆道造影仅作为一项治疗手段应用于25.9﹪(14/54)的患者中. 结论:MRCP是评价肝移植术后胆道并发症的有效影像学方法;直接胆道造影可被保留作为治疗手段之一. |
| 关键词: 肝移植、胰胆管造影术,磁共振、胆道、手术后并发症 |
| DOI：10.3724/SP.J.1008.2006.00876 |
| 投稿时间：2006-03-30修订日期：2006-05-30 |
| 基金项目: |
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| MR cholangiopancreatography alone in diagnosis of biliary complications after liver transplantation |
| JIANG Tao,WANG Jian,XIAO Xiang-sheng,LIU Guang-hua,HAN Xi-nian,LIU Shi-yuan,WANG Jin-lin |
| (第二军医大学长征医院影像科,上海,200003) |
| Abstract: |
| Objective：To evaluate the clinical value of MR cholangiopancreatography （MRCP） as the only imaging procedure in diagnosing biliary complications after orthotopic liver transplantation （OLT）. Methods： The MRCP results were analyzed in 54 consecutive patients presented with clinical or biochemical signs of biliary complications after receiving OLT, and were compared with the findings eventually confirmed by surgery, direct cholangiography, and clinical follow-up. Two different MRCP snapshot techniques were applied： thick-slab T2-weighted sequences and multi-section thin-slab T2-weighted sequences. Results： Surgery, direct cholangiography, and clinical follow-up confirmed that 36 patients had biliary complications. MRCP had a sensitivity of 100% （36/36） in diagnosing biliary complications after OLT, with a positive predictive value of 91.7% （33/ 36）, a false-positive rate of 5.56% （2/36）, and an overall diagnostic accuracy of 94.4%（51/54）. MRCP as the only imaging procedure achieved a specific diagnosis in 96.3% （52/54） of the patients in the present study. Only 2 patients required additional endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholecystostomy. Direct cholangiography was required only as a therapeutic procedure in 25.9% （14/54） of the patients. Conclusion： MRCP is an effective imaging procedure in the assessment of biliary complications after OLT. Direct cholangiography is not needed for diagnosis but should be reserved as a therapeutic procedure. |
| Key words: liver transplantation cholangiopancreatography, magnetic resonance biliary tract postoperative complications |
