目的 探讨胆总管IgG4 相关性硬化性胆管炎的临床及影像学特点.方法 回顾性分析影像学诊断为胆管恶性肿瘤,经手术或临床治疗后诊断为IgG4 相关性硬化性胆管炎患者的影像及临床资料.结果 2例MRI检查T1WI 显示胆总管中段狭窄,呈等信号; 增强扫描提示病灶持续显著强化,信号均匀、边界清晰; 冠状位扫描有利于病灶的定位; 病灶周围结构如常,近端胆管轻度扩张; DWI 序列呈高信号,提示弥散受限.1例肝门部及胆总管远端同时狭窄,经激素治疗后明显好转.3例患者的血清IgG4 均升高.结论 IgG4 相关性硬化性胆管炎的诊断需结合临床及影像学检查,其中 MRI 对于该病的诊断价值较高.%Objective To investigate the clinical and imaging features of IgG4-related sclerosing cholangitis of common bile duct. Methods The imaging and clinical data of patients,who were initially diagnosed as bile duct cancer by imaging,but, were later diagnosed as the IgG4-relatedsclerosing cholangitis by surgery or clinic,were retrospectively analyzed in this work. Results T1WI MRI examination showed the middle segment stenosis of common bile duct in two cases,exhibiting the equal signal. Enhanced scan demonstrated that the lesions were significantly continuous strengthening,with uniform signal and clear boundary. Coronal scan was conducive to the location of the lesion. The structure around the lesions presented as usual and the proximal bile duct was mild expansion. DWI sequence showed high signal,suggesting that dispersion was limited. One case was shown that both the hilar site and the distal part of the common bile duct were stenosis. After the hormone therapy,the status of the patients was significantly improved. All three patients had the elevated IgG4 in serum. Conclusion Diagnosis of IgG4-related sclerosing cholangitis requires a combination of clinical and radiological examination and the diagnostic value of MRI for the disease is high.
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