MRI和超声诊断肝内外胆管结石的ROC分析

Comparison of Magnetic Resonance Imaging with Ultrasonography in the Diagnosis of Bile Duct Stone:ROC Analysis

目的:比较MRI和超声(US)在诊断肝内外胆管结石(BDS)中的价值。方法:收集2010年5月至2011年2月拟诊BDS的住院病例共136例,在我院同时行MRI和US,以手术发现为金标准比较两种检查方法诊断BDS的准确率、灵敏度和特异度;以及比较分析两种检查方法诊断BDS的受试者工作特征(ROC)曲线。结果:该136例中,82例行手术治疗。手术证实43例有肝内胆管结石(IHL),73例有肝外胆管结石(EHL),其中34例同时有肝内外胆管结石。MRI和US诊断IHL的灵敏度、特异度和准确率分别为93.0%、94.9%和93.9%,79.1%、94.9%和86.6%;MRI和US诊断EHL的灵敏度、特异度和准确率分别为65.8%、66.7%和65.9%,93.2%、77.8%和91.5%。MRI和US诊断IHL的ROC曲线下面积分别为0.971和0.964(P>0.05);MRI和US诊断EHL的曲线下面积分别为0.855和0.776(P<0.05).结论:在诊断IHL时,MRI与US诊断价值相当,而对于EHL,MRI明显优于US。

Purpose： To compare the value of magnetic resonance imaging （MRI） and ultrasonograph） （US） in the diagnosis of bile duct stone （BDS） . Methods： A total of 136 consecutive patients with sus pected BDS were recruited from May 2010 to February 2011. They were performed both abdominal ME imaging and US at the same period before surgery. The sensitivity, specificity and accuracy of MRI ant US based on surgery were analyzed. The areas under receiver operating characteristic（ROC） curves wer（ calculated for comparing MRI with US in the diagnosis of BDS. Results： Among the 136 patients, 82 pa tients were performed surgery and were confirmed with BDS. Of the 82 patients with BDS, 43 patient, had intrahepatic lithiasis （IHL）, 73 patients （34 patients coexisted with IHL） had extrahepatic lithiasis, （EHL）. The sensitivity, specificity and accuracy of US and MRI in detecting IHL were 79.1%, 94.9 % and 86.6%, and 93.0%, 94.9% and 93.9%, respectively. The sensitivity, specificity and accuracy of US anc MRI in detecting EHL were 65.8%, 66.7% and 65.9%, and 93.2%, 77.8% and 91.5% respectively. The areas under ROC curves for MRI and US in detecting IHL were 0. 971 and 0. 964, respectively （P 〉 0.05） and in diagnosing EHL were 0. 855 and 0. 776, respectively（P 〈 0.05） . Conclusion： MRI and US have similar value in detecting IHL. However, MRI is superior to US in detecting EHL.