医药学论文：MRCP对十二指肠憩室的诊断价值

【摘要】 目的 探讨磁共振胰胆管成像（MRCP）对十二指肠憩室的诊断价值。方法 2004年3月～2005年2月，使用GE Signa 1.5T MR扫描仪，对因上腹痛或伴有黄疸的患者行MRCP检查，采用薄层（3mm层厚，零间隔）及厚层（50mm层厚）成像，在观察胰胆管的同时，着重观察十二指肠及其周围结构，以期发现憩室或其他病变。结果 共发现6例十二指肠憩室，男1例，女5例；年龄53～74岁，平均65岁。所有憩室均位于十二指肠降段与胰头之间。6例中2例显示胆总管下段受压绕行，伴有胆总管及胰管的不同程度扩张，2例合并胆总管下端结石，1例合并胆总管下段炎性狭窄，另1例较大憩室因压迫胰头区而致胰胆管扩张。所有病例均经十二指肠镜检查证实。在MRCP图像上，十二指肠憩室表现为一端连于十二指肠，另一端为游离的盲袋样结构，其形态及信号均类似于十二指肠。3例憩室内可见散在气泡影或气-液平面，以横轴位T2WI显示较佳。1例较大憩室呈盘曲状，轴位像上呈多囊样改变，增强扫描囊壁与十二指肠壁呈同等强化，囊内容物无强化。结论 MRCP对发现十二指肠憩室较为敏感，也非常准确，并能显示某些并发症；缺点是难以显示黏膜溃疡及一般炎症；但由于其为无创性检查，简便易行，患者无痛苦，故仍不失为一种较好的检查方法。
【关键词】 胰胆管成像；磁共振；十二指肠憩室；影像诊断
【Abstract】 Objective To evaluate the value of magnetic resonance cholangiopancreatography (MRCP) in detecting duodenal diverticulum.Methods From March of 2004 to Feberuary of 2005，with GE Signa 1.5 tesla MR equipment，MRCP was performed on a series of patients with abdominal pain or together with jaundice.The MRCP was performed in both thin slice (3mm thickness with no gap) and thick slice (50mm thickness).In film reading，particular attention was paid to the observation of duodenum and the surrounded structures，in addition to the observation of cholangiopancreatic ducts，so as to find if any diverticulum or other abnormalities exist.Results 6 cases of duodenal diverticulum were found.Among them，one was male and 5 were female.The age was ranged from 53 to 74 years，with an average of 65.All of the diverticula were situated between the descending section of duodenum and the pancreatic head.2 cases were complicated by choledocholith； one with inflammatory stenosis of the choledocho duct.In another case，the diverticulum was so large that the pancreatic head was heavily pressed and the cholangiopancreatic ducts dilated.All of the diverticula were confirmed by endoscopic examinations.On MRCP pictures，the duodenal diverticulum presented as a "blind duct"，with one end connected to the diverticulum，and the other end being free.The shape and signal intensity were similar to the duodenum.In 3 cases，gas bubble or gas-liquid level was observed inside of the diverticulum，which was more clearly showed on T2WI.In one case，the large diverticulum was convoluted and appeared as multiple cysts in axial images，the wall of which had a same enhancement as that of the duodenum on Gd-DTPA enhancing scan，while the contents didn't enhance.Conclusion MRCP is sensitive and accurate in detecting duodenal diverticulum，and furthermore can show some of it's complications.The shortcomings of it include the weakness in detecting the ulcer and general inflammation of the mucosa.Nevertheless，due to the harmless，easiness and painless characteristics，MRCP should be considered as a good method in detecting duodenal diverticulum and it's complications.
【Key words】 cholangiopancreatography；magnetic resonance；duodenal diverticulum；imaging diagnosis
十二指肠憩室较为常见，多发生于十二指肠降段，以往主要以上消化道钡餐造影或十二指肠镜检查诊断。2004年3月～2005年2月我院在对因上腹痛或伴有黄疸的患者行磁共振胰胆管成像（MRCP）检查时，诊断了6例十二指肠憩室，后均经十二指肠镜检查证实，现报告如下。
1 资料与方法
1.1 一般资料 6例中男1例，女5例。年龄53～74岁，平均65岁。均经十二指肠镜检查证实。6例患者均因上腹疼痛不适，2例伴有黄疸而来院就诊，病史3天～6个月。
1.2 扫描方法 使用GE Signa 1.5T MR扫描仪，TORSOPA线圈。常规行轴位SE T1WI、快速自旋回波（FSE）T2WI及脂肪抑制T2WI (T2FS)。T1WI TR 360ms，TE 10ms，2次激励，矩阵256×192，视野36cm×36cm；T2WI TR 750ms，TE 84.4ms，2次激励，矩阵320×256，视野36cm×27cm，层厚5mm，间隔1mm。薄层MRCP取冠状位，快速恢复FSE(FRFSE)序列，TR 6666ms，TE 137ms，层厚3mm，间隔0mm，3次激励，矩阵320×192。厚层MRCP采用轴位像定位辐射状扫描，单次激发快速自旋回波（SSFSE）序列，TR 3594ms，TE 1104ms，层厚50～60mm，1次激励，矩阵320×256。检查前禁饮水4h。其中1例加做了MR增强扫描，行轴位T1WI、T1FS和冠状位T1WI。造影剂为先灵公司生产的马根维显，15ml静脉注射。
2 结果
2.1 MRI表现 6例十二指肠憩室均表现为十二指肠降段与胰头之间的盲袋样结构，其信号强度与十二指肠降段相同（图1、图2）。在MRCP图像上均显示盲袋样结构，一端连于十二指肠，另一端游离（图3、图4）。3例憩室内可见气泡影或气-液平面，以横轴位T2WI显示较佳（图2、图5）。6例中2例显示胆总管下段受压绕行，伴有胆总管及胰管的不同程度扩张；2例合并胆总管下端结石。1例合并胆总管下段炎性狭窄。1例较大憩室呈盘曲状，轴位像呈多囊样改变（图5），增强扫描囊壁与十二指肠壁呈同等强化（图6）。
2.2 临床诊治情况 6例十二指肠憩室均经十二指肠镜检查证实。憩室多开口于十二指肠乳头旁，其中2例十二指肠乳头位于憩室内，1例合并肠黏膜多发溃疡及黏膜水肿。2例合并胆总管下端结石，经网篮取石后临床症状消失；另4例经抑酸、解痉及抗感染治疗病情好转。