Kats J, Kraai M, Dijkstra A J, Koster K, Ter Borg F, Hazenberg H J A, Eeftinck Schattenkerk M, des Plantes B G Ziedses, Eddes E H
Department of Surgery, Deventer Ziekenhuis, Deventer, The Netherlands.
Dig Surg. 2003;20(1):32-7. doi: 10.1159/000068863.
BACKGROUND/AIMS: The diagnostic potential of magnetic resonance cholangiopancreaticography (MRCP) has improved as a result of evolving technique. MRCP has the advantage of negligible morbidity and mortality in contrast to endoscopic retrograde cholangiopancreatography (ERCP). This study was performed to evaluate MRCP as a replacement for diagnostic ERCP for the suspicion of common bile duct (CBD) stones.
From 1998 to 2001, MRCP was performed in 202 patients with a suspicion of CBD stones based on medical history (MH), cholestatic liver function tests (CL), both MH and CL or other reasons. ERCP was performed in all patients where MRCP indicated the presence of CBD stones and in those patients with a persistent strong clinical suspicion for CBD stones despite a negative MRCP.
In 25 patients, MRCP suggested CBD stones which were proven with ERCP in 24 patients. Despite a negative MRCP, 27 patients had a subsequent ERCP. None of these patients appeared to have CBD stones. In this group, MRCP resulted in 100% sensitivity and 96% specificity in detecting CBD stones. Follow-up of all patients revealed 5 more patients with persistent clinical suspicion or cholestatic liver function values. Assuming CBD stones in these patients, MRCP had a sensitivity of 83 % and a specificity of 99% for this diagnosis.
In the case of CBD stone suspicion, MRCP should be the diagnostic procedure of choice.
背景/目的：随着技术的不断发展，磁共振胰胆管造影（MRCP）的诊断潜力有所提高。与内镜逆行胰胆管造影（ERCP）相比，MRCP具有发病率和死亡率可忽略不计的优势。本研究旨在评估MRCP作为怀疑胆总管（CBD）结石时诊断性ERCP的替代方法。
1998年至2001年，对202例基于病史（MH）、胆汁淤积性肝功能检查（CL）、MH和CL两者或其他原因怀疑有CBD结石的患者进行了MRCP检查。对所有MRCP提示存在CBD结石的患者以及尽管MRCP结果为阴性但仍有强烈临床怀疑CBD结石的患者进行了ERCP检查。
25例患者的MRCP提示有CBD结石，其中24例经ERCP证实。尽管MRCP结果为阴性，但仍有27例患者随后进行了ERCP检查。这些患者均未发现有CBD结石。在该组中，MRCP检测CBD结石的敏感性为100%，特异性为96%。对所有患者的随访发现，另有5例患者持续存在临床怀疑或胆汁淤积性肝功能值异常。假设这些患者患有CBD结石，MRCP对该诊断的敏感性为83%，特异性为99%。
在怀疑有CBD结石的情况下，MRCP应作为首选的诊断方法。
