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口服低浓度顺磁性造影剂对十二指肠 憩室的诊断价值研究

作者:陈锦华1 朱 斌1 田为中2 王秀兰2 张 继2 张 剑2

所属单位:1.南京医科大学附属鼓楼医院影像 科 (江苏 南京 210008) 2.江苏省泰州市人民医院影像科 (江苏 泰州 225300)

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摘要

目的 探讨以低浓度钆喷酸葡胺 (Gd-DTPA注射液)作为阳性造影剂进行MRI 检查对诊断十二指肠憩室的可行性。方 法 对常规检查疑似十二指肠憩室患者进 行MRI薄层及口服低浓度造影剂MRI薄层检 查。结果 55例患者65个憩室被检出,46 例位于十二指肠降部,9例位于十二指肠 水平部。MRI薄层检查59个憩室内含气液 平或气体,6个憩室仅表现为十二指肠壁 外囊袋状影;口服低浓度造影剂MRI薄层 检查65个憩室内均充填造影剂,重建图 像清晰显示憩室颈部及憩室腔形态。结 论 口服低浓度造影剂MRI薄层检查有助于 十二指肠憩室的明确诊断,MRI三维后处 理可以与上消化道钡餐检查相媲美。口服 低浓度造影剂MRI薄层检查可以作为十二 指肠憩室诊断有疑问时的有力补充。

Objective To investigate the feasibility of using the gadolinium-DTPA (GdDTPA injection) at low concentration as a positive MRI contrast agents to diagnose the duodenal diverticulum. Methods Thin layer MRI scans with and without oral contrast agents were performed in the patients with suspected duodenal diverticula. Results Among 55 patients, 46 cases were found in the descending duodenum, 9 were found in the horizontal part of duodenum. Sixty-five diverticula were detected in all the patients. Routinely thin layer MRI scans showed that 59 diverticulum contains gas-liquid borderline or gas, 6 diverticulum just exhibited as the pocket hernia shadow in duodenal wall. Thin layer MRI scans with oral contrast agent showed all 65 diverticula were filled with contrast agent. Reconstructed images displayed the cervical part and cavity of the diverticula clearly. Conclusion MRI thin layer scan with oral low concentration of contrast agent can help to the diagnosis of duodenal diverticulum. Three-dimensional reconstruction was comparable with upper gastrointestinal barium meal examination. It can be used as a powerful supplement for the suspicious diverticula diagnosis

【关键词】磁共振成像;造影剂;口服; 十二指肠憩室

【中图分类号】R445.2;R656.6+4

【文献标识码】A

【DOI】10.3969/j.issn.1672- 5131.2016.01.038

前言

 十二指肠憩室在临床上并不少见,常常通过上消化道钡餐造影、 胃十二指肠镜或ERCP检查等确定诊断。上消化道钡餐造影对其诊断的 敏感性和特异性均较高。近年来多层螺旋CT(MSCT)广泛应用于腹部检 查,大大提高了十二指肠憩室的检出率和诊断的敏感性,但是上消化 道钡餐以及MSCT均使患者受到X线辐射损伤的机会不断增大。本研究拟 利用低浓度Gd-DTPA注射液作为阳性造影剂、借助于MRI软组织分辨率 高而无X线损伤的优势准确诊断十二指肠憩室的可行性。