Arcement C M, Meza M P, Arumanla S, Towbin R B
Children's Hospital of Pittsburgh, Department of Radiology, PA 15213, USA.
Pediatr Radiol. 2001 Feb;31(2):92-7. doi: 10.1007/s002470000326.
Radiologic assessment of pancreaticobiliary ductal disease (PBDD) in children currently consists of physiologic tests (radionuclide examinations) or invasive anatomic studies (ERCP and PTC). An accurate noninvasive and reproducible examination that can direct the subsequent need for more invasive studies would be helpful in this patient group.
To determine the effectiveness of MRCP as a screening tool for PBBD in the pediatric population.
Over the last year, 33 patients ranging from 7 months to 20 years of age were prospectively evaluated with MRCP on a 1.5 T magnet. One patient was examined twice, several months apart. Thirteen patients had liver transplants. Coronal SPGR and heavily T-2W FSE cross-sectional images were obtained. Standard and oblique 2- to 6-cm-thick slab SSFSE (single-shot fast spin echo) acquisition and 3D MIP reconstruction of 2D FSE images were obtained in the planes of the CBD and pancreatic duct. Nine studies were performed with the patient under sedation with chloral hydrate or nembutal and fentanyl with quiet respiration, and the non-sedated patients were assessed with single breath hold or quiet respiration. Three patients received secretin. MRCP results were correlated with ERCP (9), PTC (7), liver biopsy (13), clinical information (6), surgery (3), and autopsy (2).
All 34 studies performed were considered diagnostic. Periportal fluid, proximal bowel fluid, and gallbladder distention did not significantly diminish the diagnostic information in any cases. Motion artifact did not cause serious degradation in image quality. MRCP depicted abnormalities including stones, stricture, intraductal tumor, and extrinsic compression, all of which were confirmed at ERCP, PTC ( two unsuccessful in patients with non-dilated ducts by MRCP), surgery, liver biopsy, and autopsy. There were no false-negative examinations. Normal pancreatic studies performed to exclude pancreas divisum were followed without additional clinical or laboratory evidence of pancreatitis. Secretin administration increased the conspicuity of the pancreatic duct in two of three patients.
MRCP is a fast non-invasive method of evaluating the pancreatic duct and biliary tree in children. A normal MRCP may obviate the need for PTC or ERCP. Abnormalities detected on MRCP can direct the type of intervention.
目前儿童胰胆管疾病（PBDD）的放射学评估包括生理学检查（放射性核素检查）或侵入性解剖学研究（内镜逆行胰胆管造影术（ERCP）和经皮肝穿刺胆管造影术（PTC））。一种能够指导后续是否需要进行更具侵入性检查的准确、无创且可重复的检查，对该患者群体将有所帮助。
确定磁共振胰胆管造影（MRCP）作为儿科人群PBBD筛查工具的有效性。
在过去一年中，对33例年龄从7个月至20岁的患者使用1.5T磁共振仪进行了前瞻性MRCP评估。1例患者在相隔数月的时间里接受了两次检查。13例患者接受了肝移植。获取了冠状面扰相梯度回波（SPGR）和重T2加权快速自旋回波（FSE）横断面图像。在胆总管和胰管平面，采用标准及斜位2至6厘米厚的单层单次激发快速自旋回波（SSFSE）采集，并对二维FSE图像进行三维最大强度投影（MIP）重建。9项检查是在患者使用水合氯醛或戊巴比妥及芬太尼镇静并平静呼吸的情况下进行的，未镇静的患者则通过单次屏气或平静呼吸进行评估。3例患者接受了促胰液素检查。MRCP结果与ERCP（9例）、PTC（7例）、肝活检（13例）、临床信息（6例）、手术（3例）及尸检（2例）结果进行了对比。
所进行的34项检查均被认为具有诊断价值。门周液体、近端肠内液体及胆囊扩张在任何情况下均未显著减少诊断信息。运动伪影未导致图像质量严重下降。MRCP显示的异常包括结石、狭窄、导管内肿瘤及外在压迫，所有这些异常在ERCP、PTC（2例MRCP显示胆管未扩张的患者检查未成功）、手术、肝活检及尸检中均得到证实。没有假阴性检查。为排除胰腺分裂症而进行的正常胰腺检查之后，未出现胰腺炎的额外临床或实验室证据。3例患者中有2例在注射促胰液素后胰管显示更清晰。
MRCP是评估儿童胰管和胆管树的一种快速无创方法。正常的MRCP结果可能无需进行PTC或ERCP。MRCP检测到的异常可指导干预类型。
