儿童先天性胆总管囊肿磁共振胆胰管成像特点及其诊断价值

肝脏 ›› 2025, Vol. 30 ›› Issue (2): 258-261.

儿童先天性胆总管囊肿磁共振胆胰管成像特点及其诊断价值

周琦芳, 武林, 陈萌萌

215000 江苏苏州大学附属儿童医院放射科

收稿日期:2024-11-12 出版日期:2025-02-28 发布日期:2025-03-17
通讯作者: 陈萌萌,Email:cmm880529@163.com
基金资助:
江苏省自然科学基金(面上)项目(BK20201175)

MR cholangiopancreatography of congenital choledochal cyst in children and its diagnostic value

ZHOU Qi-fang, WU Lin, CHEN Meng-meng

Department of Radiology, Children's Hospital Affiliated to Soochow University, Jiangsu 215000, China

Received:2024-11-12 Online:2025-02-28 Published:2025-03-17
Contact: CHEN Meng-meng, Email:cmm880529@163.com

摘要/Abstract

摘要： 目的分析儿童先天性胆总管囊肿(CCC)磁共振胆胰管成像(MRCP)特点及其诊断价值。方法 2020年1月—2023年12月苏州大学附属儿童医院收治CCC儿童90例,纳入同期进行MRI检查正常患儿50例作为对照组,比较CCC组、对照组一般MRI资料,分析CCC分型情况及其MRCP表现,并分析常规MRI、MRCP及DWI检查CCC的表现。结果 CCC组脾脏最大截面面积显著高于对照组,CCC组胆囊长短径比值显著大于对照组,另外CCC组门静脉直径显著宽于对照组,差异均具有统计学意义(P<0.05)。MRCP显示CCC患儿胆总管伴有不同程度囊形、梭形或柱状扩张。Todani分型中以1型例数最多(70例,77.8%),其中又以Ia多见(65例,72.2%),MRCP显示囊肿位于肝门至胰头之间,囊肿直径1.4～7.2 cm,其中合并胆囊结石23例(25.5%)、伴发肝内胆管扩张25例(27.8%)及胰腺炎2例(2.2%),后者表现为胰腺增大伴胰周渗出;各Todani分型中未见V型病例。Kurumi分型以C型为主。在Todani分型中以A、B型多见,共同通道1.3～2.0 cm,另有6例无胰胆管合流异常。常规MRI联合MRCP检出CCC 67例(74.4%),MRI、MRCP联合DWI诊断CCC 83例(92.2%),后者诊断正确率显著高于常规MRI联合MRCP诊断(P<0.05)。结论 MRCP在儿童CCC诊断中的重要价值,特别是在形态学评估、并发症识别及多参数影像联合应用方面具有显著优势。结合DWI的诊断模式可进一步提升影像学检查的准确性,为CCC的临床诊治提供了重要参考。

关键词: 先天性胆总管囊肿, 磁共振胆胰管成像, Todani分型

Abstract: Objective To analyze characteristics and diagnostic value of magnetic resonance cholangiopancreatography (MRCP) in children with congenital choledochal cyst (CCC). Methods Between January 2020 and December 2023, 90 children with CCC were admitted to Children's Hospital Affiliated to Soochow University, and 50 children with normal MRI examination were included as the control group. The general MRI data of CCC group and control group were compared, the CCC classification and MRCP manifestations were analyzed, and the performance of conventional MRI, MRCP and DWI examination of CCC was analyzed. Results The largest cross-sectional area of spleen in CCC group was significantly higher than that in control group, and the ratio of length to diameter of gallbladder in CCC group was significantly higher than that in control group. In addition, the diameter of portal vein in CCC group was significantly wider than that in control group, and the differences were statistically significant (P<0.05). MRCP showed that the common bile duct in CCC children was accompanied by cystic, spindle or columnar dilatation in different degrees. Among Todani's classification, type 1 was the most common (70 cases, 77.8%), and Ia was the most common (65 cases, 72.2%). MRCP showed that the cyst was located between the hilum of the liver and the head of the pancreas, with a diameter of 1.4 ~ 7.2 cm, including 23 cases with gallstones (25.5%) and 25 cases with intrahepatic bile duct dilatation (27.8%). No V-type cases were found in each Todani classification. Kurumi typing is mainly C type. In Todani classification, type A and type B were most common, the common channel was 1.3 ~ 2.0 cm, and 6 cases had no abnormal pancreaticobiliary confluence. Conventional MRI combined with MRCP detected 67 cases of CCC (74.4%), and MRI, MRCP combined with DWI diagnosed 83 cases of CCC (92.2%). The diagnostic accuracy of the latter was significantly higher than that of conventional MRI combined with MRCP (P<0.05). Conclusion MRCP plays an important role in the diagnosis of CCC in children, especially in morphological evaluation, complication identification and multi-parameter imaging combined application. Combined with DWI diagnosis mode, the accuracy of imaging examination is further improved, which provides an important reference for clinical diagnosis and treatment of CCC.

Key words: Congenital choledochal cyst, Magnetic resonance cholangiopancreatography, Todani typing

周琦芳, 武林, 陈萌萌. 儿童先天性胆总管囊肿磁共振胆胰管成像特点及其诊断价值[J]. 肝脏, 2025, 30(2): 258-261.

ZHOU Qi-fang, WU Lin, CHEN Meng-meng. MR cholangiopancreatography of congenital choledochal cyst in children and its diagnostic value[J]. Chinese Hepatolgy, 2025, 30(2): 258-261.

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