目的 比较化脓性与非化脓性胆 管炎之间MRI征象的差异，探讨MRI鉴别 化脓性与非化脓性胆管炎的临床作用。 方法 回顾性分析接受手术胆道取石并 在术中发现胆管内有脓液聚集的急性化 脓性胆管炎病例33例，随机选取合并胆 管结石的非化脓性胆管炎病例45例。在 MRI上比较化脓性和非化脓性胆管炎的胆 总管结石、肝内胆管结石、胆总管扩张 等的发生率以及胆总管结石最大径的差 异。并计算有差异的MRI征象诊断化脓性 胆管炎的敏感性、特异性、准确性。结 果 在MRI上，化脓性和非化脓性胆管炎 间胆总管结石、肝脏异常灌注的发生率 差异具有统计学意义(P≤0.05)。肝内胆 管结石、胆总管扩张、肝内胆管扩张、 胆总管增厚、胆囊炎发生率及胆总管结 石最大径在化脓性胆管炎和非化脓性胆 管炎间差异无统计学意义(P≥0.05)。多 元回归分析胆总管结石、肝脏异常灌注 是预测化脓性胆管炎较有意义的MRI指 标。胆总管结石诊断化脓性胆管炎的敏 感性较高，为60%，肝脏异常灌注诊断化 脓性胆管炎的特异性较高，为79%，联合 胆总管结石和肝脏异常灌注两个指标诊 断化脓性胆管炎的特异性可达到85%。结 论 在MRI上，肝脏异常灌注、胆总管结 石可作为鉴别化脓性胆管炎与非化脓性 胆管炎较有价值的征象，为临床诊断、 治疗方案的选择提供帮助。

Objective To compare the MRI findings between the acute suppurative cholangitis and nonsuppurative cholangitis, and to evaluate the role of MRI finding in the differential diagnosis. Methods To retrospectively study 33 patients with acute suppurative cholangitis whom were confirmed pus accumulation of biliary ducts during the surgical removal of biliary duct stones. 45 patients with nonsuppurative cholangitis and biliary duct stones were randomly selected. The following MRI findings were compared and analysed: the presence of common bile duct stones, intrahepatic bile duct stones, bile duct dilatation, intrahepatic bile duct dilation, bile duct thickening, cholecystitis, and hepatic abnormal lperfusion, and the maximum diameter of the common bile duct stones. The sensitivity, specificity and accuracy of MRI findings in the diagnosis of suppurative cholangitis were calculated. Results On MRI, there were significant difference between acute suppurative cholangitis and nonsuppurative cholangitis for the presence of common bile duct stones and hepatic abnormal perfusion(P≤0.05), and there were no significant difference between acute suppurative cholangitis and nonsuppurative cholangitis for the presence of intrahepatic bile duct stones, bile duct dilatation, intrahepatic bile duct dilation, bile duct thickening, cholecystitis, and the maximum diameter of the common bile duct stones(P≥0.05).In multivariate logistic analysis, common bile duct stones and hepatic abnormal perfusion were the significant MRI predictors of acute suppurative cholangitis. Common bile duct stones showed higher accuracy with 60%, hepatic abnormal perfusion showed higher specificity with 79%, the combination of the two MRI findings improved the specificity with 85% in diagnosis of acute suppurative cholangitis. Conclusion On MRI, the common bile duct stones and hepatic abnormal perfusion were valuable findings to different acute suppurative cholangitis and nonsuppurative cholangitis, and can provide help for clinical diagnosis and treatment options.