Kondo Shintaro, Isayama Hiroyuki, Akahane Masaaki, Toda Nobuo, Sasahira Naoki, Nakai Yosuke, Yamamoto Natsuyo, Hirano Kenji, Komatsu Yutaka, Tada Minoru, Yoshida Haruhiko, Kawabe Takao, Ohtomo Kuni, Omata Masao
Department of Gastroenterology, Department of Radiology, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Japan.
Eur J Radiol. 2005 May;54(2):271-5. doi: 10.1016/j.ejrad.2004.07.007.
New modalities, namely, endoscopic ultrasonography (EUS), magnetic resonance cholangiopancreatography (MRCP), and helical computed-tomographic cholangiography (HCT-C), have been introduced recently for the detection of common bile duct (CBD) stones and shown improved detectability compared to conventional ultrasound or computed tomography. We conducted this study to compare the diagnostic ability of EUS, MRCP, and HCT-C in patients with suspected choledocholithiasis.
Twenty-eight patients clinically suspected of having CBD stones were enrolled, excluding those with cholangitis or a definite history of choledocholithiasis. Each patient underwent EUS, MRCP, and HCT-C prior to endoscopic retrograde cholangio-pancreatography (ERCP), the result of which served as the diagnostic gold standard.
CBD stones were detected in 24 (86%) of 28 patients by ERCP/IDUS. The sensitivity of EUS, MRCP, and HCT-C was 100%, 88%, and 88%, respectively. False negative cases for MRCP and HCT-C had a CBD stone smaller than 5mm in diameter. No serious complications occurred while one patient complained of itching in the eyelids after the infusion of contrast agent on HCT-C.
When examination can be scheduled, MRCP or HCT-C will be the first choice because they were less invasive than EUS. MRCP and HCT-C had similar detectability but the former may be preferable considering the possibility of allergic reaction in the latter. When MRCP is negative, EUS is recommended to check for small CBD stones.
最近已引入了新的检查方法，即内镜超声检查（EUS）、磁共振胰胆管造影（MRCP）和螺旋计算机断层扫描胆管造影（HCT-C），用于检测胆总管（CBD）结石，并且与传统超声或计算机断层扫描相比，其检测能力有所提高。我们开展本研究以比较EUS、MRCP和HCT-C对疑似胆总管结石患者的诊断能力。
纳入28例临床疑似患有CBD结石的患者，排除患有胆管炎或有明确胆总管结石病史的患者。每位患者在进行内镜逆行胰胆管造影（ERCP）之前均接受了EUS、MRCP和HCT-C检查，ERCP结果作为诊断金标准。
通过ERCP/IDUS在28例患者中的24例（86%）检测到CBD结石。EUS、MRCP和HCT-C的敏感性分别为100%、88%和88%。MRCP和HCT-C的假阴性病例中CBD结石直径小于5mm。未发生严重并发症，不过1例患者在HCT-C检查中注入造影剂后出现眼睑瘙痒。
如果可以安排检查时间，MRCP或HCT-C将是首选，因为它们的侵入性比EUS小。MRCP和HCT-C具有相似的检测能力，但考虑到后者可能发生过敏反应，前者可能更可取。当MRCP结果为阴性时，建议采用EUS检查是否存在小的CBD结石。
