The Study Of Hypotonic MR Manifestation Of Normal Duodenal Papilla And Disease In Ampullary Portion

[Objective] To evaluate the hypotonic MR manifestation of normal duodenal papilla to provide an important reference for diagnosing disease in ampullary portion; To analyse the hypotonic MR manifestation of the different disease in ampullary portion.[Materials and methods] 1 Normal group 45 cases of voluntees were studied with hypotonic MRI. Male group(23 cases) and Female group (22 cases) ,ranging from 23 to 78-years-old, the average age of 45.7. MR imaging equipment is GE 1.5T SIGNA.First of all scaning SSFSE/AX, COR, FSPGR-T1WI, BH Thick slab MRCPs FIESTA/AX, COR sequence. And then,Hypotonic MR scan is startuped after 5 minute injecting scopolamine butylbromide injection(20mg) with water(150-200 ml). Before and after injecting of drugs the patients of posture and imaging parameters remain the same, to carry out self-control.Finally,analyzed MRI manifestation of normal duodenal papilla, and injecting hypotonic medicine before and after MR image quality improvements to statistical analysis; 2 clinical group 35 patients with susspect of lesions in ampullary portion were studied by hypotonic MRI scan, all cases have been surgery(16 cases), endoscopy and (or) pathology(5 cases), clinical follow-up(14 cases) confirmed. Male 25 cases,Female 10 cases ,ranging from 28 to 82-years-old, the average age of 52.3. To observe MRI manifestation of the different disease in ampullary portion.[Results] 1 The study of normal group (1)Images analysis: Injection before and after hypotonic medicine of the image quality of MRCP and MRI were analyzed and compared from inhibition of the motion artifact by intestines,exoantion degree of duodenal and the manifestation of the ampulla demonstrating anatomy that aspect in three, result: image quality of hypotonic MR scanning was markedly improved;(2) scopolamine butylbromide injection only have smaller drug side effects;(3) Of these 45 cases, 41 were good in hypotonic effect. The longest duodenal diameter on the slice of duodenal papilla was 2.48 cm. Of these 45 cases, 39 were good in showing duodenal papilla, the longest diameter of duodenal papilla was (0.69±0.13) cm. The most diameter of duodenal papilla between male group and female group had no significant difference(P> 0. 05);(4) After injecting hypotonic medicine,there was no significant difference (P> 0.05) in showing duodenal papilla between the SS-FSE and FIASTA sequences. 2 The study of clinical group Of these 35 patients, 30 cases confirmed by surgery, endoscopy and (or) pathology, clinical follow-up accordant with MRI diagnosis of reliability of determining focus, diagnostic accordance rate is 85.7%; 33 cases confirmed accordant with MRI diagnosis of accuracy of location of focus, diagnostic accordance rate is 94.3%.[Conclusion] 1.Hypotonic MR scan can improve effectively the quality of MRCP and MRI images;2.Scopolamine butylbromide injection is a kind of ideal hypotonic medicine,because of good hypotonic effects and lower side-effects; 3. Hypotonic MRI manifestation of normal ampulla shows duodenum is dilated moderately, and duodenal papilla could be seen clearly, and normal duodenal papilla has 3 types: semicircular, mastoid and compressed. The longest diameter of duodenal papilla was (0.69±0.13) cm;4. The SS-FSE and FIASTA sequences are good in showing duodenal papilla, their are both taked as routine scan sequences to extensive pancreaticobiliary duct diseases;5.To analyse the MRI characters of diaeases in ampullary portion afer hypotonic MR scan, and it has important clinical value of the diagnosis and differential diagnosis of different diseases in ampullary portion.