| Object: Hepatic alveolar echinococcosis combined with bile duct damage is a common manifestation of patients and an important limiting factor for reducing the rate of surgical resection in patients with echinococcosis.Therefore,this study used MRI to comprehensively assess the impact of lesion location,size,and type on intrahepatic biliary tree,and provide imaging evidence for clinical surgical resection and prediction of postoperative biliary complications.Methods: The MRI routine scan,magnetic resonance cholangiopancreatography and biliary reconstruction were performed on 140 patients with hepatic alveolar echinococcosis confirmed by clinical and pathology from June 2016 to June 2018.The following contents were studied:1.Morphological changes of bile duct damage in hepatic alveolar echinococcosis under MRCP: Chi-square test was used to evaluate the difference of morphological changes of biliary lesions in 183 lesions,and sensitivity and specificity of MRCP in the diagnosis of bile duct morphological changes;2.Chisquare test was used to compare left hepatic ducts.Invasion rate of right hepatic duct and common hepatic duct;3.Chi-square test was used to evaluate the influence of position,size and type of 183 lesions on postoperative bile leakage.According to the presence or absence of bile leakage,it was divided into normal group and bile leakage group;4.Characteristics of bile duct lesions of 59 hilar echinococcosis and bile duct lesions of 45 hilar cholangiocarcinoma Chi-square test was used to compare bile duct dilatation,wall thickening,wall enhancement and bile duct soft tissue imaging differences in performance.Result: 1.Morphological changes of bile duct lesions in hepatic alveolar echinococcosis under MRCP: mainly bile duct compression and obstruction dilatation,bile duct truncation and obstruction dilatation;Bile duct lesions in left hepatic lobe and right hepatic lobe were treated with bile duct compression and obstruction,the main expansion was 19(37.3%)and 36(49.3%);The lesions in the hilar region were mainly bile duct truncation and obstruction expansion,a total of 37(62.7%);For lesions less than 5cm in diameter,the bile duct was not affected mainly,a total of 15(41.7%);The lesions were 5-10 cm,mainly due to bile duct compression and obstructive dilation,with a total of 32(51.6%);Diameter greater than 10 cm,mainly bile duct truncation and obstruction expansion,a total of 42(49.4%);Liquefied necrotic lesions,mainly bile duct truncation and obstruction expansion,a total of 36(46.2%);Parenchymal and mixed type were mainly biliary compression and obstruction expansion,accounting for 45.5%,41.0%;The sensitivity,specificity and AUC of MRCP in the diagnosis of bile duct damage were 0.783,0.727 and 0.755,respectively;2.Total bile duct invasion rate was 36.6%,left hepatic duct,right hepatic duct,and hepatic duct invasion the rates were 26.4%,41.4% and 42.1%,respectively,and the overall P<0.05.Through the consistency test with surgery,the Kappa coefficients of the three were 0.602,0.695,and 0.741,respectively;3.Postoperative bile leakage: 64 in the normal group.There were 119 leaked groups,and the lesions were different from the occurrence of bile leakage,P<0.05,of which liver Mainly,the composition ratio was 40.3%;The diameter of the lesion was different from that of bile leakage,P<0.05,the diameter of the lesion was greater than 10 cm,and the ratio of bile leakage occurred was 63(52.9%);While the normal group was the diameter of the lesion.Less than 5cm,the composition ratio was 65.6%;there was no difference between lesion type and bile leakage,P>0.05;4.Both bile duct wall thickening,bile duct wall enhancement,bile duct soft tissue mass imaging showed differences,composition ratio 80%,100%,100%,P<0.05;Bile duct dilatation,no statistical difference,P>0.05.Conclusion: MRI combined with MRCP can accurately assess the damage of the lesion to the biliary tract.It has important guiding significance for the accurate treatment and differential diagnosis of HAE. |
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