MRCP与ERCP鉴别肝外胆管良恶性狭窄的对比研究

Comparison of MRCP and ERCP for Differentiating Benign or Malignant Stricture of Extrahepatic Bile Duct

目的:探讨肝外胆管良、恶性狭窄患者的磁共振胰胆管成像(magnetic resonance cholangio-pan-creatography,MRCP)与内镜逆行胆胰管造影术(endoscopic retrograde cholangiopancreatography,ER-CP)的征象,并比较两种检查方法诊断的准确性。方法:对46例经手术或病理检查明确病因的肝外胆管狭窄患者的术前MRCP和ERCP资料进行回顾性分析,根据图像肝外胆管狭窄的形态描述为边缘不规则或平滑、狭窄不对称或对称、狭窄中断或呈鼠尾状及双管征等,计算MRCP与ERCP诊断的灵敏度、特异度及准确性,用标尺准确测量肝外胆管狭窄的长度,并用t检验来比较。结果:肝外胆管癌表现为不规则边缘和不对称狭窄(92%)较良性狭窄(分别为22%,35%)普遍。MRCP诊断肝外胆管癌与良性狭窄的灵敏度、特异度及准确性分别是84%、71%及78%,ERCP分别是72%、71%及72%。肝外胆管癌引起狭窄长度平均是(30.0±8.5)mm,良性狭窄平均长度是(13.6±9.1)mm(P<0.001)。结论:MRCP在鉴别诊断肝外胆管良恶性的病变引起胆管狭窄与ERCP相比是较准确的。

Objectlve：To observe the signs obtained from the magnetic resonance cholangiopan - creatography （MRCP） and endoscopic retrograde cholangiopancreatography （ERCP） in the patients with benign or malignant stricture of extrahepatic bile duct, and compare the diagnostic accuracy of both methods, Methods： The image data obtained from MRCP and ERCP in 46 patients were retrospectively analyzed. Strictures of extrahepatic bile duct were described according to their imaging appearance as irregular or smooth margins, asymmetric or symmetric narrowing, abrupt narrowing or gradual tapering, and presence or absence of double -duct sign. Sensitivity, specificity, and accuracy of MRCP and ERCP were evaluated. The lengths of stricture were exactly measured by using scales and compared by employing the Student t test. Results：The irregular border and asymmetric narrowing were more common in cancers of extrahepatic biliary duet （92%） than in benign strictures （22% and 35% respectively）. The sensitivity, specificity, and accuracy of MRCP for differentiating malignant from benign causes of biliary stricture were 84% ,71%, and 78% , respeetively; that of ERCP were 72% ,71% ,and 72%, respectively. The lengths （ mean ± standard deviation） of stricture were （30.0 ±8.5 ） mm in eholangioearcinomas and （ 13.6 ±9. 1 ） mm benign strictures （ P 〈 0. 001 ）. Conclusion： Employing MRCP to make differential diagnosis of stricture of bile duct induced by a benign or malignant disease is more precise than using ERCP.