Di Cesare Ernesto, Puglielli Edoardo, Michelini Osvaldo, Pistoi Maria Antonietta, Lombardi Loreto, Rossi Mauro, Barile Antonio, Masciocchi Carlo
Cattedra di Radiologia, Università degli Studi di l'Aquila, L'Aquila, Italy.
Radiol Med. 2003 May-Jun;105(5-6):445-53.
To compare the diagnostic accuracy of MR cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of malignant stenosis of the distal common bile duct.
Twenty-one patients (12 males and 9 females, mean age 62 years) with a clinical suspicion of malignancy of the distal biliary tract and pancreatic head underwent tomographic RM evaluation and diagnostic MRCP, followed by diagnostic and, where possible, therapeutic ERCP. The images obtained with ERCP and MRCP were reviewed blind by two experts who evaluated the presence, site, signal features and locoregional extension of the tumours. Histology performed by brushing or biopsy during ERCP and after surgical resection provided the standard of reference for all 21 patients.
CPRM correctly identified the presence and site of the distal biliary stenosis in 21/21 (100%) cases, as well as allowing evaluation of the upper abdomen by associating it with conventional MRI. ERCP, instead, allowed detection of the presence and site of biliary stenosis in 20/21 (95%) cases.
ERCP may have some limitations as regards identification of distal bile duct stenosis in cases of critical stenosis. The non-invasive nature and panoramic capabilities of MRCP and the fact that no contrast material is needed make MRCP the examination of reference in the diagnosis of malignant stenosis of the distal bile duct, also thanks to its ability to visualise the entire biliary tree in the presence of critical strictures of the common bile duct. The rationale for the use of ERCP lies in the possibility of taking histological samples and performing minimally invasive surgical interventions.
比较磁共振胰胆管造影（MRCP）和内镜逆行胰胆管造影（ERCP）在诊断胆总管远端恶性狭窄方面的诊断准确性。
21例临床怀疑远端胆道和胰头恶性肿瘤的患者（12例男性，9例女性，平均年龄62岁）接受了断层磁共振成像评估和诊断性MRCP，随后进行了诊断性ERCP，并在可能的情况下进行了治疗性ERCP。由两名专家对ERCP和MRCP获得的图像进行盲法评估，他们评估肿瘤的存在、部位、信号特征和局部扩展情况。在ERCP期间以及手术切除后通过刷检或活检进行的组织学检查为所有21例患者提供了参考标准。
MRCP在21/21（100%）的病例中正确识别出胆总管远端狭窄的存在和部位，并且通过与传统MRI相结合还能对上腹部进行评估。相反，ERCP在20/21（95%）的病例中检测到了胆道狭窄的存在和部位。
在严重狭窄的情况下，ERCP在识别胆总管远端狭窄方面可能存在一些局限性。MRCP的非侵入性、全景成像能力以及无需使用对比剂的特点，使其成为诊断胆总管远端恶性狭窄的参考检查方法，这还得益于其在胆总管严重狭窄时能够显示整个胆道树的能力。使用ERCP的理由在于有可能获取组织学样本并进行微创外科干预。
