磁共振虚拟胆道镜检查的临床应用价值

Value of Virtual Magnetic Resonance Cholangiography in Clinical Practice

目的探讨磁共振虚拟胆道镜(magnetic resonance virtual cholangiography,MRVC)诊断胆道系统病变的临床应用价值。方法用3.0T磁共振仪对87例胆道疾病患者行3D快速自旋回波胆胰管水成像(3D-TSE-MRCP)检查,用随机配备的虚拟内镜软件对检查资料进行3D重建,形成虚拟胆道镜视频资料。以术中所见、病理检查及ERCP+EST取石术明确诊断,计算胆囊、胆管结石MRVC的敏感性、特异性、阳性和阴性预测值。例数较少病例结合临床相关资料对MRVC视频图像进行具体分析。结果 MRVC诊断胆囊结石敏感性、特异性、阳性和阴性预测值分别为71.8%(51/71)、75.0%(6/8)、96.2%(51/53)和23.1%(6/26),胆管结石的上述指标分别为87.5%(28/32)、98.2%(54/55)、96.6%(28/29)和93.1%(54/58)。结论虚拟胆道镜具有直观形象、无创伤、可重复等独特优越性,是对2D成像技术和传统纤维内镜的良好补充。

Objective To evaluate the value of virtual magnetic resonance cholangiography （VMRC） in diagnosing biliary diseases. Methods A total of 87 patients with biliary diseases underwent 3 dimensional turbo spin echo MR cholangiopancreatography （3D-TSE-MRCP） by 3.0T MR imaging. The raw data were sent to the auxiliary workstation and post-processed by VMRC to reconstruct 3D video data. The diagnosis of the patients were made by observation during operation,pathology and ERCP＋EST. The sensitivity,specificity,positive and negative predicative values of virtual VMRC for gallstone and bile duct stones were calculated. In a few cases,VMRC video data were analyzed together with clinical data. Results The sensitivity,specificity,positive and negative predictive values of VMRC for gallstones were 71.8% （51/71）,75.0% （6/8）,96.2% （51/53）,and 23.1% （6/26）,respectively. While those for bile duct calculi were 87.5% （28/32）,98.2% （54/55）,96.6% （28/29）,and 93.1% （54/58）. Conclusions VMRC has advantages in direct surgical view,non-invasion and repeatability. It can be an alternative to 2D imaging and fiberoptic endoscope.