Taylor Andrew C F, Little Andrew F, Hennessy Oliver F, Banting Simon W, Smith Peter J, Desmond Paul V
Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia.
Gastrointest Endosc. 2002 Jan;55(1):17-22. doi: 10.1067/mge.2002.120324.
Traditionally, ERCP has been the only reliable method for imaging the biliary tree, but it is invasive and carries a risk of complications. Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive method for imaging the biliary tree. The aim of this study was to prospectively assess the accuracy of MRCP in a large number of patients.
Consecutive patients referred to a teaching hospital for ERCP were eligible for study entry. MRCP was performed within 24 hours before ERCP. MRCP findings were compared with ERCP findings or, when the initial ERCP was unsuccessful, with results of repeat ERCP, percutaneous transhepatic cholangiography, or surgery.
One hundred forty-six patients underwent 149 ERCP/MRCP procedures, of which 129 were evaluable with successful MRCP and ERCP or an ERCP-equivalent study. Diagnoses included choledocholithiasis in 46 and biliary stricture in 12 patients. The sensitivity, specificity, positive, and negative predictive values for MRCP in the diagnosis of choledocholithiasis were 97.9%, 89.0%, 83.6%, and 98.6%, respectively. All 12 strictures were diagnosed by MRCP (sensitivity 100%, specificity 99.1%).
MRCP is an accurate, noninvasive alternative to ERCP for imaging the biliary tree. Choledocholithiasis and biliary strictures can be reliably diagnosed or excluded by MRCP. MRCP should be used increasingly in patients with suspected biliary obstruction to select those who require a therapeutic procedure.
传统上，内镜逆行胰胆管造影（ERCP）一直是胆管成像的唯一可靠方法，但它具有侵入性且有并发症风险。磁共振胰胆管造影（MRCP）是一种胆管成像的非侵入性方法。本研究的目的是前瞻性评估大量患者中MRCP的准确性。
连续转诊至教学医院进行ERCP的患者符合研究入组条件。在ERCP前24小时内进行MRCP。将MRCP结果与ERCP结果进行比较，或者当初次ERCP不成功时，与重复ERCP、经皮肝穿刺胆管造影或手术结果进行比较。
146例患者接受了149次ERCP/MRCP检查，其中129次检查可评估，MRCP和ERCP均成功或进行了等效于ERCP的检查。诊断包括46例胆总管结石和12例胆管狭窄。MRCP诊断胆总管结石的敏感性、特异性、阳性预测值和阴性预测值分别为97.9%、89.0%、83.6%和98.6%。所有12例狭窄均由MRCP诊断（敏感性100%，特异性99.1%）。
MRCP是一种准确的、非侵入性的胆管成像替代ERCP的方法。MRCP可可靠地诊断或排除胆总管结石和胆管狭窄。对于疑似胆道梗阻的患者，应越来越多地使用MRCP来选择那些需要进行治疗性操作的患者。
