胆总管下段梗阻的MRI误漏诊分析

Analysis of MRI misdiagnosis and missed diagnosis in low level biliary obstruction

目的对胆总管下段梗阻的MRI检查误漏诊原因进行分析总结。方法选择经手术、内镜逆行胰胆管造影(ERCP)或病理学确诊的胆总管下段梗阻患者246例,均行常规序列、磁共振胰胆管造影(MRCP)、动态增强扫描。依据良、恶性病变分为两组,良性病变组177例和恶性病变组69例。对其中51例误漏诊原因进行分析总结。结果良性梗阻MRI诊断准确率80.8%(143例),误漏诊率19.2%(34例),误诊为其他良性病变27例,误诊为其他恶性病变3例,漏诊4例;恶性梗阻MRI诊断准确率75.4%(52例),误漏诊率24.6%(17例),误诊为其他恶性病变11例,误诊为其他良性病变5例,漏诊1例。总误漏诊51例。结论 MRI对胆总管下段梗阻诊断的准确率较高,良性组稍高于恶性组,误漏诊原因与病变过小、各种因素干扰、影像特征分析不到位、罕少见病例认识不足、忽略合并的其他病变、缺乏典型征象等相关。诊断医师需总结经验、与临床紧密结合,部分结果仍需依赖手术、ERCP或病理学检查。

Objective To retrospectively analyze the diagnosis of MRI in the lower part of common bile duct ob- struction and the causes of misdiagnosis and missed diagnosis. Methods 246 patients with low level biliary obstruction confirmed by surgery, endoscopic retrograde cholangiopancreatography （ERCP） or pathology under- went conventional sequences, magnetic resonance cholangiopancreatography （MRCP） and dynamic enhanced scanning. The causes of misdiagnosis and missed diagnosis were analyzed. Results In 177 cases of benign obstruction, MRI diag- nostic accuracy rate was 80.8% （143 cases）, misdiagnosis rate was 19.2% （34 cases）, 27 cases were misdiagnosed as other benign lesions, 3 cases were misdiagnosed as other malignant lesions, 4 cases were missed diagnosis. In 69 cases of malignant obstruction, MRI diagnostic accuracy rate was 75.4% （52 cases）, misdiagnosis rate was 24.6% （17 cases）, 11 cases were misdiagnosed as other malignant lesions, 5 cases were misdiagnosed as other benign lesions, 1 cases were missed diagnosis. Conclusion The accuracy of MRI in the diagnosis of common bile duct obstruction is high. The malig- nant group is slightly higher than that in benign group. Small lesions, interference of various factors, error analysis of image features, lack of knowledge of rare cases, ignoring other lesions, lack of typical signs etc are the reasons. Physi- cians need to sum up experience, combine with clinical data. Some of the results still need to rely on surgery, ERCP or pathological examination.