目的探究磁共振胰胆管造影(MRCP)诊断不同直径、不同部位胆总管结石(CBDS)的价值。方法选取2019年9月至2022年9月我院175例疑似CBDS患者,均行术前超声、CT及MRCP,以内镜下逆行胰胆管造影术(ERCP)检查结果为“金标准”,统计术前超声、CT...目的探究磁共振胰胆管造影(MRCP)诊断不同直径、不同部位胆总管结石(CBDS)的价值。方法选取2019年9月至2022年9月我院175例疑似CBDS患者,均行术前超声、CT及MRCP,以内镜下逆行胰胆管造影术(ERCP)检查结果为“金标准”,统计术前超声、CT及MRCP诊断CBDS的结果,比较3种方法诊断CBDS的价值,并比较超声、CT、MRCP诊断不同直径、不同部位CBDS的准确度,根据术前MRCP诊断结果选择手术方案,统计一次取石成功率。结果基于ERCP检查结果的“金标准”,术前MRCP诊断CBDS的敏感度(95.83%)、准确度(95.43%)均高于超声、CT诊断(P<0.05);MRCP诊断结石直径<5 mm CBDS的准确度(88.00%)均高于超声、CT诊断,诊断直径5~10 mm CBDS的准确度(96.83%)高于超声诊断(P<0.05),诊断直径>10 mm CBDS的准确度为100.00%;MRCP诊断上段CBDS的准确度(96.88%)均高于超声、CT诊断,诊断胰腺段CBDS的准确度(92.68%)高于超声诊断(P<0.05),诊断壶腹段CBDS的准确度为100.00%。结论MRCP诊断CBDS的敏感度、准确度较高,在不同直径、不同部位CBDS诊断方面均具有很高准确度,可为手术取石提供可靠术前参考依据。展开更多
BACKGROUND High-grade pancreatic intraepithelial neoplasia(PanIN)exhibits no mass and is not detected by any examination modalities.However,it can be diagnosed by pancreatic juice cytology from indirect findings.Most ...BACKGROUND High-grade pancreatic intraepithelial neoplasia(PanIN)exhibits no mass and is not detected by any examination modalities.However,it can be diagnosed by pancreatic juice cytology from indirect findings.Most previous cases were diagnosed based on findings of a focal stricture of the main pancreatic duct(MPD)and caudal MPD dilatation and subsequent pancreatic juice cytology using endoscopic retrograde cholangiopancreatography(ERCP).We experienced a case of high-grade PanIN with an unclear MPD over a 20-mm range,but without caudal MPD dilatation on magnetic resonance cholangiopancreatography(MRCP).CASE SUMMARY A 60-year-old female patient underwent computed tomography for a follow-up of uterine cancer post-excision,which revealed pancreatic cysts.MRCP revealed an unclear MPD of the pancreatic body at a 20-mm length without caudal MPD dilatation.Thus,course observation was performed.After 24 mo,MRCP revealed an increased caudal MPD caliber and a larger pancreatic cyst.We performed ERCP and detected atypical cells suspected of adenocarcinoma by serial pancreatic juice aspiration cytology examination.We performed a distal pancreatectomy and obtained a histopathological diagnosis of high-grade PanIN.Pancreatic parenchyma invasion was not observed,and curative resection was achieved.CONCLUSION High-grade Pan-IN may cause MPD narrowing in a long range without caudal MPD dilatation.展开更多
文摘目的 探究MRI及MRCP在胆道梗阻性疾病定位和定性诊断的应用价值。方法 回顾性分析2017年11月至2019年11月在上海中医药大学附属岳阳中西医结合医院经手术病理或临床证实的72例胆道梗阻性疾病患者的临床资料,所有患者均行MRI及MRCP检查,其中42例加行CT检查,对不同影像学检查结果进行对比分析。结果 MRI联合MRCP、MRI、CT检查的定位诊断准确率分别为100%(72/72)、94.4%(68/72)、78.6%(33/42),定性诊断准确率分别为95.8%(69/72)、86.1%(62/72)、66.7%(28/42)。上述3种影像学检查均做的42例中,MRI联合MRCP检查较CT检查的定位诊断[100%(42/42) vs 78.6%(33/42),χ^(2)=10.080,P<0.05]和定性诊断[90.5%(38/42) vs 66.7%(28/42),χ^(2)=7.071,P<0.05]的准确率差异均有统计学意义,MRI联合MRCP与MRI、MRI与CT检查比较,定位诊断和定性诊断的准确率差异均无统计学意义(P>0.05)。结论 MRI联合MRCP可显著提高对胆道梗阻性病变的检出率和确诊率。
文摘目的探究磁共振胰胆管造影(MRCP)诊断不同直径、不同部位胆总管结石(CBDS)的价值。方法选取2019年9月至2022年9月我院175例疑似CBDS患者,均行术前超声、CT及MRCP,以内镜下逆行胰胆管造影术(ERCP)检查结果为“金标准”,统计术前超声、CT及MRCP诊断CBDS的结果,比较3种方法诊断CBDS的价值,并比较超声、CT、MRCP诊断不同直径、不同部位CBDS的准确度,根据术前MRCP诊断结果选择手术方案,统计一次取石成功率。结果基于ERCP检查结果的“金标准”,术前MRCP诊断CBDS的敏感度(95.83%)、准确度(95.43%)均高于超声、CT诊断(P<0.05);MRCP诊断结石直径<5 mm CBDS的准确度(88.00%)均高于超声、CT诊断,诊断直径5~10 mm CBDS的准确度(96.83%)高于超声诊断(P<0.05),诊断直径>10 mm CBDS的准确度为100.00%;MRCP诊断上段CBDS的准确度(96.88%)均高于超声、CT诊断,诊断胰腺段CBDS的准确度(92.68%)高于超声诊断(P<0.05),诊断壶腹段CBDS的准确度为100.00%。结论MRCP诊断CBDS的敏感度、准确度较高,在不同直径、不同部位CBDS诊断方面均具有很高准确度,可为手术取石提供可靠术前参考依据。
文摘BACKGROUND High-grade pancreatic intraepithelial neoplasia(PanIN)exhibits no mass and is not detected by any examination modalities.However,it can be diagnosed by pancreatic juice cytology from indirect findings.Most previous cases were diagnosed based on findings of a focal stricture of the main pancreatic duct(MPD)and caudal MPD dilatation and subsequent pancreatic juice cytology using endoscopic retrograde cholangiopancreatography(ERCP).We experienced a case of high-grade PanIN with an unclear MPD over a 20-mm range,but without caudal MPD dilatation on magnetic resonance cholangiopancreatography(MRCP).CASE SUMMARY A 60-year-old female patient underwent computed tomography for a follow-up of uterine cancer post-excision,which revealed pancreatic cysts.MRCP revealed an unclear MPD of the pancreatic body at a 20-mm length without caudal MPD dilatation.Thus,course observation was performed.After 24 mo,MRCP revealed an increased caudal MPD caliber and a larger pancreatic cyst.We performed ERCP and detected atypical cells suspected of adenocarcinoma by serial pancreatic juice aspiration cytology examination.We performed a distal pancreatectomy and obtained a histopathological diagnosis of high-grade PanIN.Pancreatic parenchyma invasion was not observed,and curative resection was achieved.CONCLUSION High-grade Pan-IN may cause MPD narrowing in a long range without caudal MPD dilatation.