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目的:评价MR平扫、MRCP、DWI序列及MR动态增强扫描等不同MR检查方法对肝门部胆管癌的诊断价值。方法:回顾性分析经手术及病理证实的9例肝门部胆管癌在上述不同MRI检查方法中所显示的影像特征,提高对肝门部胆管癌的诊断认识。结论:肝门部胆管癌在MRI平扫上表现为边界不清的等、稍长T1信号稍高T2混杂信号团块,MRCP可明确显示肝门区肝管狭窄、截断征象,远侧肝管的显著扩张,DWI序列病灶表现为扩散受限稍高信号,MR动态增强扫描动脉期病变表现为不强化或轻度强化,程度不一的延迟强化较具特征性,同时增强MR对胆管壁和邻近肝实质的侵犯、血管侵犯以及肝门、腹膜后淋巴结转移有明显的诊断价值。合理选择上述多种MRI检查方法结合临床胆管癌相关抗原、CA19-9检测能对大多数肝门部胆管癌做出正确诊断,对疾病的诊断、分型、临床治疗路径选择具有重要价值。
OBJECTIVE: To evaluate the diagnostic value of MR MR, MRCP, DWI and MR dynamic contrast-enhanced MR imaging in the diagnosis of hilar cholangiocarcinoma. Methods: Nine cases of hilar cholangiocarcinoma confirmed by operation and pathology were retrospectively analyzed, and the imaging features showed in the different MRI examination methods mentioned above were retrospectively analyzed to improve the diagnosis of hilar cholangiocarcinoma. Conclusions: The hilar cholangiocarcinoma shows unclear boundary on MR plain scan. The slightly longer T1 signal is slightly higher than the T2 mixed signal mass. MRCP can clearly show the hepatic duct stenosis and truncation in the hilar region. The distal hepatic duct DWI showed focal lesion with slightly higher signal diffusion, MR dynamic enhanced arterial lesion showed no enhancement or mild enhancement, with varying degrees of delay to strengthen the more characteristic, while enhancing MR on the bile duct wall and Adjacent to the liver parenchyma violations, vascular invasion and hilar and retroperitoneal lymph node metastasis have obvious diagnostic value. Reasonable choice of a variety of MRI examination combined with clinical cholangiocarcinoma antigen, CA19-9 detection of most of the hilar cholangiocarcinoma to make the correct diagnosis of disease diagnosis, classification, clinical treatment of path selection has important value.