磁共振胰胆管成像和直接胰胆管造影对胆胰疾病诊断价值自身对比的前瞻性研究

A prospective study of diagnostic value of MRCP versus ERCP in cholangiopancreatic diseases

目的 比较直接胰胆管造影 (ERCP和PTC)和磁共振胰胆管成像 (MRCP)对胆胰疾病的诊断价值。方法 临床怀疑胆胰系疾病 63例。每例先行MRCP ,在此后 2 4h内行ERCP。影像科和内镜医师分别报告自己所见结果 ,待研究结束后 ,以ERCP或PTC为参照标准行统一对比分析。结果 63例行ERCP中 ,成功率为 88.9% ( 5 6/63例 ) ,7例ERCP失败者改行PTC检查成功 ;所有MRCP均获成功 ,成功率为 10 0 .0 % ;MRCP的灵敏度为 98.2 %、特异度 83 .3 %、误诊率为 16.7%、漏诊率为 1.8%。MRCP和ERCP(或PTC)总符合率 85 .7% ,其中在胆系结石及胆管肿瘤分别为 10 0 .0 %和 92 .9% ,乳头部病变为 70 .6% ( 12 /17例 ) ,在慢性胰腺炎和肝吸虫的诊断符合率分别为 3 /3和 66.7%。 63例ERCP者 ,术后并发胰腺炎 5例、肾周脓肿 1例 (为B Ⅱ术后 ) ,并发症发生率为 9.5 % ( 6/63例 ) ;而MRCP无并发症发生。结论 对胆管内疾病 ,MRCP可达到ERCP的单纯诊断水平 ,而对乳头部病变 (尤其是小病变 )和肝吸虫 ,MRCP却无法与ERCP相比拟。对不能耐受ERCP及有禁忌症者 ,MRCP是较好的选择。MRCP的最大不便在于不能同时进行治疗。

ObjectiveThe diagnostic value of magnetic resonance cholangiopan creatography (MRCP) versus endoscopic retrograde cholangiopancreatography(ERCP) was compared prospectively in the detection of cholangiopancreatic diseases.MethodsSixty-three patients with suspected cholangiopancreatic diseases underwent MRCP. Then thoatieuey were followed by ERCP within 24 hours. The findings of MRCP images were analyzed and compared with ERCP. ResultsAmong the 63 patients, 56 patients (88.9%) were diagnosed accurately by ERCP, 7 patients (11.1%) were diagnosed by percutaneous transhepatic cholangiography (PTC) in addition to ERCP. However, all of the patients were able to be diagnosed by MRCP. The sensitivity of MRCP was 98.2%, specificity was 83.3%, misdiagnostic rate was 16.7%, omission diagnostic rate was 1.8%. The total diagnostic accordance of MRCP and ERCP was 85.7%. In respect of the individual diseases, the accordance was 100% in cholelithe, 92.9% in tumor of bile duct, 70.6%(12/17) in papillary lesion, 66.7% in hepatic distomiasis, 3/3 in chronic pancreatitis, respectively. The complication of ERCP included acute pancreatitis (5), perinephric abscess (1) who underwent B-Ⅱ operation before. The rate of complication of ERCP was 9.5%(6/63). MRCP had no complication. ConclusionsMRCP share the same diagnostic value with ERCP for the diagnosis of bile duct lesions, such as cholelithe and tumor, not for papillary lesion and hepatic distomiasis. Although there was no complications occurred with MRCP examination, it lacked treatment value in compare with ERCP.