Park Do Hyun, Kim Myung-Hwan, Lee Sang Soo, Kim Sun Young, Kim Jung Ho, Kim Hyun Jun, Bae Jong Suk, Seo Dong Wan, Lee Sung Koo, Kim Ah Young, Kim Tae Kyoung, Min Young Il
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Korea.
Korean J Gastroenterol. 2003 Nov;42(5):423-30.
BACKGROUND/AIMS: Diagnosis of bile duct strictures as well as detection and localization of hepatolithiasis is important for an effective treatment of hepatolithiasis. For this purpose, endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) have been preferred as the diagnostic modalities of choice for hepatolithiasis. At present, magnetic resonance cholangiopancreatography (MRCP) is rapidly replacing ERCP. To determine the usefulness and limitation of MRCP for detecting hepatolithiasis and biliary strictures, we compared the result of MRCP with that of percutaneous transhepatic cholangioscopy (PTCS) as the standard reference.
Sixty-six patients with primary hepatolithiasis who underwent both MRCP and PTCS were enrolled. All patients underwent PTCS within 2 weeks of MRCP. The results of MRCP were reviewed by radiologists who were unaware of the clinical information about the location of hepatolithiasis and the presence of biliary strictures.
The sensitivity and specificity of MRCP for detecting intrahepatic stones were 72.4 and 90%, respectively. The sensitivity of MRCP for depicting intrahepatic bile duct strictures was 64%. The overall agreement between MRCP and PTCS for intrahepatic stones showed a good reliability (kappa value=0.64, p<0.05). The agreement of MRCP for hepatolithiasis with intrahepatic bile duct strictures with reference to PTCS showed a moderate reliability (kappa value=0.47, p<0.05). Imaging findings such as pneumobilia and hepatic parenchymal atrophy were related to false positive results in location of hepatolithiasis (p<0.05).
MRCP has a good agreement rate in evaluation of intrahepatic stones and a moderate agreement rate in intrahepatic strictures, compared to PTCS.
背景/目的：胆管狭窄的诊断以及肝内胆管结石的检测和定位对于肝内胆管结石的有效治疗至关重要。为此，内镜逆行胰胆管造影（ERCP）和经皮肝穿刺胆管造影（PTC）一直是肝内胆管结石首选的诊断方法。目前，磁共振胰胆管造影（MRCP）正在迅速取代ERCP。为了确定MRCP在检测肝内胆管结石和胆管狭窄方面的有效性和局限性，我们将MRCP的结果与作为标准参考的经皮肝穿刺胆管镜检查（PTCS）的结果进行了比较。
纳入66例同时接受MRCP和PTCS检查的原发性肝内胆管结石患者。所有患者在接受MRCP检查后2周内接受PTCS检查。由不了解肝内胆管结石位置和胆管狭窄情况的临床信息的放射科医生对MRCP的结果进行评估。
MRCP检测肝内结石的敏感性和特异性分别为72.4%和90%。MRCP显示肝内胆管狭窄的敏感性为64%。MRCP与PTCS在肝内结石方面的总体一致性显示出良好的可靠性（kappa值=0.64，p<0.05）。MRCP在肝内胆管结石合并肝内胆管狭窄方面与PTCS的一致性显示出中等可靠性（kappa值=0.47，p<0.05）。诸如胆道积气和肝实质萎缩等影像学表现与肝内胆管结石定位的假阳性结果相关（p<0.05）。
与PTCS相比，MRCP在评估肝内结石方面具有良好的一致性，在肝内狭窄方面具有中等一致性。
