三维磁共振胰胆管成像诊断小儿胆道闭锁价值分析

Application of three-dimensional magnetic resonance cholangiopancreatography in diagnosis of biliary atresia in children

目的研究磁共振成像(MRI)三维磁共振胰胆管成像(3D-MRCP)诊断小儿胆道闭锁(BA)的临床价值。方法2016年4月~2020年4月我院收治的疑似BA患儿24例,接受常规MRI和3D-MRCP检查。对患儿采取Kasai术,以手术后组织病理学检查结果为金标准,判断3D-MRCP诊断BA的效能。结果24例疑似BA患儿均顺利完成手术,术后组织病理学检查诊断BA 22例(91.7%),其中包括胆总管闭锁(Ⅰ型)2例(8.3%),肝总管闭锁(Ⅱ型)2例(8.3%),肝门部胆管闭锁(Ⅲ型)18例(75.0%);胆总管囊肿1例(4.2%)和胆道系统正常1例(4.2%);3D-MRCP准确诊断BA 21例,胆总管囊肿1例,把胆总管闭锁(Ⅰ型)漏诊为胆总管囊肿1例,把婴儿肝炎综合征胆道正常患儿误诊为BA 1例;3D-MRCP诊断BA的灵敏度为95.5%,特异度为50.0%,准确率为95.8%,阳性预测值为95.5%,阴性预测值为50.0%,与手术后组织病理学诊断的一致性检验的Kappa值为0.455(P<0.05)。结论3D-MRCP对BA具有较高的诊断效能,可帮助临床医生做出早期诊断。

Objective The aim of this study was to investigate the clinical value of three-dimensional magnetic resonance cholangiopancreatography(3D-MRCP)in the diagnosis of infantile biliary atresia(BA).Methods 24 children with suspected BA were admitted to our hospital between April 2016 and April 2020,and all underwent routine MRI and 3D-MRCP examination.The diagnostic efficacy of MRCP was evaluated by histopathological examination as a gold standard.Results 24 children with suspected BA were successfully completed surgery,andthe pathological examination showed BA in 22(91.7%)children,including BA typeⅠin 2(8.3%),BA typeⅡin2(8.3%)and typeⅢin 18(75.0%),choledochal cyst in 1(4.2%)and normal biliary system in 1(4.2%);the 3D-MRCPdiagnosed BA in 21,choledochal cyst in 1,while misdiagnosed BA as choledochal cyst in 1,and misdiagnosed infantile hepatitis syndrome with normal biliary tract system as BA in 1;the sensitivity of 3D-MRCP in the diagnosis of BA was 95.5%,with the specificity of 50.0%,the accuracy of 95.8%,the positive predictive value of 95.5%,the negative predictive value of 50.0%,and the Kappa value of consistency with pathological diagnosis was 0.455(P<0.05).Conclusion The application of 3D-MRCP has a high diagnostic efficiency for infants with BA,which could guide the clinicians dealing with this entity appropriately early.