Shamiyeh A, Lindner E, Danis J, Schwarzenlander K, Wayand W
Ludwig Boltzmann Institute for Operative Laparoscopy, 2nd Surgical Department, Academic Teaching Hospital, Linz, Krankenhausstrasse 9, 4020 Linz, Austria.
Surg Endosc. 2005 Aug;19(8):1130-4. doi: 10.1007/s00464-004-2167-6. Epub 2005 May 26.
This study aimed to compare an 18-s fast spin echo magnetic resonance image sequence (coronal thick-section two-dimensional breathhold) with a three-dimensional axial and coronal thin-section sequence and its secondary reconstruction, and to assess its value in the diagnosis of bile duct pathologies, particularly common bile duct stones (CBDS) before laparoscopic cholecystectomy.
This study prospectively included 72 patients. Because of protocol violations, 14 of these patients had to be excluded. Thus, 58 patients (29 Man and 29 women with a mean age of 51 years) who had cholecystolithiasis or suspected choledocholithiasis were evaluated. Magnetic resonance cholangiopancreatography (MRCP) was performed for all patients with a fast sequence (18 s) and a long sequence (coronal oblique and axial respiratory triggered; 16 min). Two radiologists, blinded with respect to diagnosis, evaluated all the radiographic images. The MRCP results were confirmed for all the patients: 20 by endoscopic retrograde cholangiopancreatography, 46 by intraoperative cholangiography, and 2 by percutaneous transhepatic cholangiography.
According to the findings, 16 patients (28%) had CBDS, 6 patients (10%) had common bile duct stenosis, and 36 patients (62%) had a clear bile duct. With regard to CBDS, the short sequence had 100% specificity, 94% sensitivity, and an overall accuracy of 98%. Its negative predictive value was 98%, and its positive predictive value was 100%. The long sequence had a specificity of 100% and a sensitivity of 100%.
Because of its high sensitivity and specifity, MRCP has the potential to be the diagnostic method of choice for CBD evaluation. The short sequence is not suitable for the diagnosis of all CBD pathologies, but in cases of suspected CBDS, more than 80% of the patients could be diagnosed correctly, and the complete sequence could be dropped.
本研究旨在比较18秒快速自旋回波磁共振成像序列（冠状厚层二维屏气）与三维轴向和冠状薄层序列及其二次重建，并评估其在胆管病变诊断中的价值，特别是在腹腔镜胆囊切除术前行胆总管结石（CBDS）诊断中的价值。
本研究前瞻性纳入72例患者。由于违反方案，其中14例患者不得不被排除。因此，对58例患有胆囊结石或疑似胆总管结石的患者（29例男性和29例女性，平均年龄51岁）进行了评估。对所有患者均采用快速序列（18秒）和长序列（冠状斜位和轴向呼吸触发；16分钟）进行磁共振胰胆管造影（MRCP）检查。两名对诊断不知情的放射科医生对所有影像学图像进行了评估。所有患者的MRCP结果均得到证实：20例通过内镜逆行胰胆管造影、46例通过术中胆管造影、2例通过经皮肝穿刺胆管造影得到证实。
根据检查结果，16例患者（28%）患有CBDS，6例患者（10%）患有胆总管狭窄，36例患者（62%）胆管清晰。对于CBDS，短序列的特异性为100%，敏感性为94%，总体准确率为98%。其阴性预测值为98%，阳性预测值为100%。长序列的特异性为100%，敏感性为100%。
由于其高敏感性和特异性，MRCP有潜力成为胆总管评估的首选诊断方法。短序列不适用于所有胆总管病变的诊断，但在疑似CBDS的病例中，超过80%的患者可以得到正确诊断，完整序列可以省略。
