三维磁共振胰胆管造影联合呼吸触发技术在原发性硬化性胆管炎诊断中的应用：与内镜逆行胰胆管造影的比较

Three-dimensional magnetic resonance cholangiopancreatography with respiratory triggering in the diagnosis of primary sclerosing cholangitis: comparison with endoscopic retrograde cholangiography.

作者信息

Textor H J, Flacke S, Pauleit D, Keller E, Neubrand M, Terjung B, Gieseke J, Scheurlen C, Sauerbruch T, Schild H H

机构信息

Dept of Radiology, Bonn University Hospital, Bonn, Germany.

出版信息

Endoscopy. 2002 Dec;34(12):984-90. doi: 10.1055/s-2002-35830.

DOI:10.1055/s-2002-35830

PMID:12471543

Abstract

BACKGROUND AND STUDY AIMS

The purpose of this study was to evaluate the accuracy of respiratory-triggered three-dimensional magnetic resonance cholangiopancreatography (3D-MRCP) for the detection of primary sclerosing cholangitis (PSC) and to compare the specific findings of magnetic resonance cholangiography and endoscopic retrograde cholangiography in patients with PSC.

PATIENTS AND METHODS

The MRCP findings were evaluated in 150 patients with clinical symptoms (progressive fatigue, pruritus followed by icterus) and/or elevated values for alkaline phosphatase and serum aspartate transaminase, and occasionally an elevated serum concentration of bilirubin as a sign of cholestasis, who were consecutively referred for magnetic resonance imaging. Two observers independently classified bile duct abnormalities and established the MRCP diagnosis in a consensus reading. The results of MRCP were compared with the definitive diagnosis, which was based on the clinical history and laboratory and histological data, as well as on endoscopic retrograde cholangio-pancreatography (ERCP) findings. In a second step, the observers compared the delineation of the biliary system and morphological findings using MRCP and ERCP in patients with confirmed PSC.

RESULTS

Diagnostic examinations were obtained in 146 of the 150 MRCPs (97 %). The diagnosis of PSC was confirmed by clinical data and ERCP in 34 of these 150 patients (23 %). The sensitivity and specificity of MRCP for diagnosing PSC were 88 % (29 of 33) and 99 % (108 of 109), respectively. MRCP and ERCP yielded similar scores for the delineation of the biliary system (P = 0.2) in patients with PSC. However, different bile duct abnormalities leading to the diagnosis of PSC were depicted by MRCP and ERCP; more bile duct stenoses and pruning were seen with ERCP and more skip dilatation with MRCP (P < 10(-4)).

CONCLUSION

In patients with PSC, MRCP is a highly sensitive method and its diagnostic accuracy is comparable to that of ERCP.

摘要

背景与研究目的

本研究旨在评估呼吸触发三维磁共振胰胆管造影（3D-MRCP）检测原发性硬化性胆管炎（PSC）的准确性，并比较PSC患者磁共振胆管造影与内镜逆行胆管造影的具体表现。

患者与方法

对150例有临床症状（进行性疲劳、瘙痒继而黄疸）和/或碱性磷酸酶及血清天冬氨酸转氨酶值升高，偶尔血清胆红素浓度升高作为胆汁淤积征象的患者进行磁共振成像检查，这些患者是连续转诊来的。两名观察者独立对胆管异常进行分类，并通过共识解读确定MRCP诊断。将MRCP结果与基于临床病史、实验室及组织学数据以及内镜逆行胰胆管造影（ERCP）结果的确诊诊断进行比较。第二步，观察者比较确诊PSC患者使用MRCP和ERCP时胆管系统的描绘及形态学表现。

结果

150例MRCP检查中146例（97%）获得了诊断性检查结果。这150例患者中34例（23%）经临床数据和ERCP确诊为PSC。MRCP诊断PSC的敏感性和特异性分别为88%（33例中的29例）和99%（109例中的108例）。在PSC患者中，MRCP和ERCP对胆管系统描绘的评分相似（P = 0.2）。然而，MRCP和ERCP显示导致PSC诊断的胆管异常不同；ERCP显示更多胆管狭窄和修剪，而MRCP显示更多节段性扩张（P < 10⁻⁴）。