Yeh Benjamin M, Breiman Richard S, Taouli Bachir, Qayyum Aliya, Roberts John P, Coakley Fergus V
Department of Radiology, University of California San Francisco, Box 0628, C-324C, 505 Parnassus Ave, San Francisco, CA 94143-0628, USA.
Radiology. 2004 Mar;230(3):645-51. doi: 10.1148/radiol.2303021775.
To compare biliary tract depiction in living potential liver donors at conventional magnetic resonance (MR), mangafodipir trisodium-enhanced excretory MR, and multi-detector row computed tomographic (CT) cholangiography.
Eight living potential liver donors underwent iodipamide meglumine-enhanced CT cholangiography. Eight different potential liver donors then underwent conventional MR cholangiography and mangafodipir trisodium-enhanced excretory MR cholangiography. Two readers independently scored all first-, second-, and third-order biliary branches with a four-point scale from 0 (not seen) to 3 (excellent visualization). Interobserver agreement was calculated by using the weighted kappa statistic. Scores were compared between imaging modalities by using generalized estimating equations. Imaging findings of second-order biliary tract anatomy were compared with intraoperative findings for nine patients.
Interobserver agreement for overall biliary tract visualization was good for CT, conventional MR, and excretory MR cholangiography (with weighted kappa values of 0.76, 0.66, and 0.79, respectively). The mean second-order biliary branch visualization scores for readers 1 and 2, respectively, were significantly higher at CT cholangiography (2.81 and 2.75) than at conventional MR (1.84 and 1.75, P <.001), excretory MR (2.00 and 2.06, P <.001), and combined conventional and excretory MR cholangiography (2.31 and 2.25, P <.01). At CT, conventional MR, and excretory MR cholangiography, respectively, second-order biliary branching anatomy was discernible in eight, five, and seven patients, with second-order biliary branch variants seen in three, two, and two patients. Surgical findings confirmed the pattern of second-order biliary branching seen at CT in five patients, that seen at conventional MR imaging in one patient, and that seen at excretory MR cholangiography in three patients. At surgery, one case of variant biliary anatomy was found to have been missed at CT cholangiography.
In living potential liver donors, CT cholangiography enables significantly better biliary tract visualization than conventional or excretory MR cholangiography either alone or in combination.
比较常规磁共振成像（MR）、锰福地匹三钠增强排泄性MR及多排螺旋计算机断层扫描（CT）胆管造影对活体肝供者胆道的显示情况。
8名活体肝供者接受了胆影葡胺增强CT胆管造影。另外8名不同的潜在肝供者随后接受了常规MR胆管造影及锰福地匹三钠增强排泄性MR胆管造影。两名阅片者采用从0分（未显示）至3分（显示极佳）的4分制对所有一级、二级和三级胆管分支进行独立评分。采用加权kappa统计量计算观察者间的一致性。通过广义估计方程比较不同成像方式的评分。将9例患者的二级胆管解剖结构的影像学表现与术中所见进行比较。
CT、常规MR及排泄性MR胆管造影对胆道整体显示的观察者间一致性良好（加权kappa值分别为0.76、0.66和0.79）。阅片者1和阅片者2对二级胆管分支的平均显示评分在CT胆管造影时（分别为2.81和2.75）显著高于常规MR（分别为1.84和1.75，P <.001）、排泄性MR（分别为2.00和2.06，P <.001）以及常规与排泄性MR胆管造影联合检查时（分别为2.31和2.25，P <.01）。在CT、常规MR及排泄性MR胆管造影检查中，二级胆管分支解剖结构分别在8例、5例和7例患者中可辨别，二级胆管分支变异分别在3例、2例和2例患者中可见。手术结果证实，5例患者CT显示的二级胆管分支模式、1例患者常规MR成像显示的模式以及3例患者排泄性MR胆管造影显示的模式与术中所见相符。手术中发现1例胆管解剖变异在CT胆管造影时漏诊。
在活体肝供者中，CT胆管造影对胆道的显示明显优于单独或联合应用的常规或排泄性MR胆管造影。
