腹腔镜胆囊切除术前MRCP诊断胆总管结石的检查方案优化研究

A Study for Optimization of the Examination Program in Preoperative Evaluation of Common Bile Stones with MRCP Before Laparoscopic Cholecystectomy

目的通过比较7个磁共振胰胆管成像(MRCP)序列在不同配合度情况下图像质量及对胆总管结石的诊断性能,优化腹腔镜胆囊切除术(LC)术前MRCP检查方案。资料与方法 125例行7个序列的MRCP检查,根据患者不同的屏气与呼吸触发配合度分成9组。两名放射科医师使用双盲法对二维图像质量进行评价,使用单因素方差分析。同时计算7个序列诊断胆总管结石的敏感性、特异性、假阳性率、假阴性率、总的诊断正确率。结果9组7个MRCP序列二维图像质量评分差别有显著统计学意义(P<0.01)。B1R1组FIESTA 2D B、FIESTA 3DB、FRFSE 2D R、SSFSE 2D B Thk图像质量好;B1R2组与B1R3组FIESTA 2D B、FIESTA 3D B、SSFSE 2D B Thk图像质量好;B2R1组FRFSE 2D R、SSFSE 2D B Thk图像质量好;B2R2组与B2R3组SSFSE 2D B Thk、FIESTA 2D B、FI-ESTA 3D B、SSFSE 2D B Thn、FRFSE 3D B图像质量好;B3R1组FRFSE 2D R图像质量最好;B3R2组与B3R3组FI-ESTA 2D B、SSFSE 2D B Thk图像质量好。7个序列诊断胆总管结石的敏感性、特异性、假阳性率、假阴性率、总的诊断正确率分别为FRFSE 3D R,72%、98%、2%、28%、89.5%;FRFSE 2D R,92.6%、100%、0%、7.4%、97.5%;FIES-TA 2D B,93.5%、97.1%、2.9%、6.5%、96%;SSFSE 2D B Thk,87.9%、81.8%、18.2%、12.1%、83.8%;FRFSE 3DB,89.7%、100%、0%、10.3%、96.8%;FIESTA 3D B,82.1%、100%、0%、17.9%、94.6%;SSFSE 2D B Thn,90.9%、97%、3%、9%、95%。结论 LC术前诊断胆总管结石的MRCP优化检查方案为:呼吸触发配合度达到一级优先使用FRFSE 2D R;呼吸触发配合度不能达到一级的建议使用FIESTA 2D B。

Objective To evaluate and compare the imaging quality of 7 different MRCP sequences in patients with different degrees of respiratory cooperation,and assess the diagnosis performance for the common bile duct（CBD） stone to optimize the MRCP examination program.Materials and Methods There were 125 patients performed MRCP examination with 7 sequences.According to different degrees of cooperation in breath holding and respiratory triggering,125 patients were divided into 9 groups.The diagnosis of CBD and qualitative analyses were completed independently by two radiologists who were blind for patients＇ clinical information.The sensitivity,specificity,false positive rate,false negative rate,diagnostic accuracy of diagnosis of common bile duct stones in difference sequences were also calculated.The difference of imaging quality among all groups was evaluated by one way analysis of variance（ANOVA）.Results Imaging quality of two dimensional image in 7 different sequences in 9 groups was statistically different（P 0.01）.Fiesta 2D B,Fiesta 3D B,FRFSE 2D R,and SSFSE 2DB Thk had better imaging quality in group of B1 R1;Fiesta 2D B,Fiesta 3D B and SSFSE 2DB Thk were better for groups of B1 R2 and B1 R3;FRFSE 2D R and SSFSE 2DB Thk were better for B2 R1;SSFSE 2DB Thk,Fiesta 2D B,Fiesta 3D B,SSFSE 2DB Thn,and FRFSE 3D B were better for B2 R2 and B2 R3;FRFSE 2D R was better for B3 R1;Fiesta 2D B,and SSFSE 2DB Thk were better for B3 R2 and B3 R3.Sensitivity,specificity,false positive rate,false negative rate and diagnostic accuracy of diagnosis of common bile duct stones in the all sequences were： FRFSE 3D R,72%,98%,2%,28%,89.5%;FRFSE 2D R,92.6%,100%,0%,7.4%,97.5%;Fiesta 2D B,93.5%,97.1%,2.9%,6.5%,96%;SSFSE 2DB Thk,87.9%,81.8%,18.2%,12.1%,83.8%;FRFSE 3D B,89.7%,100%,0%,10.3%,96.8%;Fiesta 3D B,82.1%,100%,0%,17.9%,94.6%;SSFSE 2DB Thn,90.9%,97%,3%,9%,95%,respectively.Conclusion Optimal examination programs for evaluation of the CBD stones before LC are： patients with the first degree of respiratory triggering cooperation,choose FRFSE 2D R preferentially;otherwise Fiesta 2D B is suggested.