Peri-pancreatic Lymphatics : Evaluation with 3. 0T MR imaging(fat-suppressed T2-weighted images with a three-dimensional spectral pre-saturation with inversion recovery volume isotropic turbo spin echo acquisition)

目的腹盆淋巴管的详细解剖仅在身体上进行过研究。目前还没有关于胰胆管淋巴管的磁共振成像的报道。本研究的目的是评价正常胰胆淋巴管在3.0-T磁共振成像上的可见性。材料与方法27例疑似肝胆疾病并被诊断为良性病变(如肝囊肿、肝血管瘤)的患者作为正常胰胆淋巴管的受试者。磁共振成像方案包括脂肪抑制的T2加权图像和三维频谱预饱和和恢复体积各向同性的快速自旋回波采集(SPIR Vista)。为了图像解释，将胰头和肝十二指肠韧带周围的淋巴管分为8段。每个节段的可见度由两名观察员根据预先定义的5分置信度标准进行独立评级。通过Kappa统计对观察者间的一致性进行评估。结果每段肝十二指肠韧带前上段100%，前中段89%，前下段85%，上、中、下后段及右侧腹膜上动脉与肠系膜上动脉之间以及肝十二指肠韧带周围96%。观察者间的一致性好或好。结论正常情况下的胰胆淋巴管在SPIR三维成像中可以在脂肪抑制的T2加权图像上得到充分显示。

PurposeDetailed anatomy of abdominopelvic lymphatics has been studied only in cadavers. There is no report regarding the MR imaging of pancreatobiliary lymphatics. The purpose of this study was to assess the visibility of normal pancreatobiliary lymphatics on 3. 0-T MR imaging.Materials and MethodsTwenty-seven patients who were suspected of hepatic or pancreatobiliary diseases and diagnosed as benign pathologies(e. g., hepatic cysts, hepatic hemangioma) were evaluated as subjects having normal pancreatobiliary lymphatics. The MR imaging protocol consisted of fat-suppressed T2-weighted images with a three-dimensional spectral pre-saturation with inversion recovery volume isotropic turbo spin echo acquisition(SPIR VISTA). For image interpretation, the lymphatics surrounding the pancreatic head and hepatoduodenal ligament were divided into eight segments. Visibility of each segment was rated independently by 2 observers according to predefined criteria on a 5-point confidence scale. Interobserver agreement was assessed by Kappa statistics. The final opinion was reached by consensus.ResultsEach segment was visualized as follows : 100% of the anterior upper portion, 89% of the anterior middle portion, 85% of the anterior lower portion, 100% of the upper and middle to lower posterior portions as well as the right side portion between the celiac and superior mesenteric arteries, and 96% of the surrounding area of the hepatoduodenal ligament. Good or excellent interobserver agreement was determined.ConclusionPancreatobiliary lymphatics under normal conditions could be sufficiently visualized on fat-suppressed T2-weighted images with a three-dimensional SPIR VISTA.