The Value Of MRCP In The Diagnosis Of Periampullary Diverticula

Background and ObjectiveMagnetic resonance cholangiopancreatography (MRCP) is a imaging techniquewhich show the pancreatic duct structure without use of contrast agent.Since the90sof last century, Wallner[1]used magnetic resonance equipment for successfulcholangiopancreatography, with the development of updated technology hasmatured.Due to its non-invasive, safe and easy, no radiation, etc., the most importantis that diagnostic accuracy can be compared with conventional invasive imagingtechniques such as ERCP, PTC, etc.So it makes the diagnosis of biliary andpancreatic diseases can be extensive. MRCP use heavy T2-weighted technology tomake T2time longer organ such as bile duct, stomach and duodenum clearly show,and with the surrounding tissue in stark contrast. PAD is located at duodenaldiverticula within2~3cm range, due to the special nature of their relationship withthe anatomical location of bile duct, sometimes resulting in the biliary and pancreaticdiseases, which clinical called papillae (Lemmel’s syndrome).Because PAD is oftenassociated with biliary and pancreatic diseases, and many studies have confirmed thatPAD and bile duct stones, pancreatitis was associated[2-6].However, due to theperformance of periampullary diverticula lack of specificity is not subject to clinicalattention that could easily lead to misdiagnosis.Diagnosis of duodenal diverticulum rely mainly on gastrointestinal contrast, ERCP before MRCP use in clinicalapplications. With the growing number of clinical applications of MRCP, foundedcases of papillary diverticulum is also increasing.The purpose of this study is to summarize the character of periampullarydiverticula in MRCP and MRI images.Based on the relationship between the PADand the bile duct on MRCP,Exploring the diagnostic value of MRCP for PAD and therelationship between PAD with the biliary and pancreatic.Materials and MethodsCollected45cases of PAD patients in MRCP which was confirmed by ERCP inMRI examination room of the Second Affiliated Hospital of Zhengzhou Universityfrom January,2010to September,2013.A retrospective analysis of the image data ofthese45patients.21males and24females, mean age was71years. All patients weretreated with3D-MRCP sequence, axial fat-suppressed T2WI sequences, breath-holdfat-suppressed coronal FIESTA sequence, axial and coronal breath LAVA threeenhanced sequence scanning.After MIP images processed by the two highqualification diagnostician for independent film-reading, the consensus diagnosis anddifferential diagnosis. By PAD imaging findings on MRCP, MRI, measured themaximum diameter of the diverticulum, summarized its signal characteristics andlocation. The combined number of cases of PAD for biliary and pancreatic diseasesclassified, statistics PAD,s diameter and position relations with or without commonbile duct stones, the application SPSS17.0software for statistical analysis.Results45cases of PAD,2cases of multiple diverticula, a total of47.MRCP showedpouch pocket inside shadow descending part of the duodenum,29(61.8%)PAD,sneck with duodenal mucosa is continuous; Axial fat-suppressed T2WI sequenceshowed the cystic shadow inside of the duodenal and the right rear of pancreatic,clear boundary,26PAD (55.3%) visible liquid surface. LAVA three enhanced scanshow diverticulum no enhancement,diverticular wall is thin and smooth, with intestinal signals.After the MIP image processing of MRCP display PAD was65.9%(31/47),the MIP image processing of MRCP+the original thin MRCP image+axialT2WI sequence PAD display rate of95.6%(45/47), the difference was statisticallysignificant compared (P <0.05).The incidence of PAD with biliary and pancreatic diseases was80%(36/45), inwhich the common bile duct stones was44.4%(20/45).Merged choledocholithiasisPAD has a larger diameter, compared with the common bile duct stones without PADdiameter, the difference was statistically significant (P <0.05). Horizontal andperipheral diverticulum with choledocholithiasis was no significant difference (P>0.05).Conclusion1.Periampullary diverticula has more typical characteristic performance in theMRCP image, the localization and qualitative diagnosis of periampullarydiverticulum in MRCP are more accurate,3D-MRCP combined with axial T2WIsequence can be used as a diagnostic sequence preference. MRCP combined withplain and enhanced MRI scan can make a timely diagnosis of the biliary andpancreatic disease,at the same time, suggesting correlation diverticula andbiliopancreatic diseases, to help clear clinical etiology, diagnosis and treatment.2.Size of periampullary diverticula may have some relevance for the formationof common bile duct stones.