Park Do Hyun, Kim Myung-Hwan, Lee Sung Koo, Lee Sang Soo, Choi Jung Sik, Lee Yoon Seon, Seo Dong Wan, Won Hyung Jin, Kim Min-Young
Department of Internal Medicine, Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Gastrointest Endosc. 2005 Sep;62(3):360-6. doi: 10.1016/j.gie.2005.04.026.
MRCP is rapidly replacing diagnostic ERCP in various pancreaticobiliary diseases. This study was designed to evaluate the accuracy of MRCP in detecting and determining the extent of choledochal cysts, as well as associated ductal anomalies or lesions.
The study design was an 8-year retrospective survey conducted at a tertiary referral center, Asan Medical Center (University of Ulsan College of Medicine, Seoul, Korea). There were 72 patients with choledochal cysts. All patients underwent both MRCP and ERCP. MRCP findings were compared with those of ERCP as the criterion standard.
The overall detection rate of MRCP for choledochal cysts was 96% (69/72). The sensitivity, the specificity, the positive predictive value, and the negative predictive value of MRCP for classifying choledochal cysts according to Todani's classification were 81%, 90%, 86%, and 86% in type I, respectively; 73%, 100%, 100, and 95% in type III, respectively; 83%, 90%, 80%, and 91% in type IVa, respectively; 100%, 100%, 100%, and 100% in type IVb, respectively; and 100%, 100%, 100%, and 100% in type V, respectively. The sensitivity, the specificity, and the accuracy of MRCP for detecting ductal anomalies were 83%, 90%, and 86%, respectively. The detection rate of MRCP for concurrent cholangiocarcinoma and choledocholithiasis was 87% (13/15) and 100% (8/8), respectively.
MRCP showed overall good accuracy in the detection and the classification of choledochal cysts and revealed associated cholangiocarcinoma and choledocholithiasis with excellent accuracy. MRCP, therefore, may supersede the diagnostic role of ERCP for the patients with choledochal cysts. However, MRCP showed limited capacity to detect minor ductal anomalies or small choledochocele.
磁共振胰胆管造影（MRCP）正在迅速取代诊断性内镜逆行胰胆管造影（ERCP）用于各种胰胆管疾病。本研究旨在评估MRCP在检测和确定胆总管囊肿的范围以及相关胆管异常或病变方面的准确性。
本研究设计为在三级转诊中心——韩国首尔峨山医学中心（蔚山大学医学院）进行的一项为期8年的回顾性调查。共有72例胆总管囊肿患者。所有患者均接受了MRCP和ERCP检查。将MRCP的检查结果与作为标准对照的ERCP检查结果进行比较。
MRCP对胆总管囊肿的总体检出率为96%（69/72）。根据托达尼分类法，MRCP对胆总管囊肿进行分类的敏感性、特异性、阳性预测值和阴性预测值在I型中分别为81%、90%、86%和86%；在III型中分别为73%、100%、100%和95%；在IVa型中分别为83%、90%、80%和91%；在IVb型中分别为100%、100%、100%和100%；在V型中分别为100%、100%、100%和100%。MRCP检测胆管异常的敏感性、特异性和准确性分别为83%、90%和86%。MRCP对并发胆管癌和胆总管结石的检出率分别为87%（13/15）和100%（8/8）。
MRCP在胆总管囊肿的检测和分类方面总体准确性良好，并且能以极高的准确性发现相关的胆管癌和胆总管结石。因此，对于胆总管囊肿患者，MRCP可能会取代ERCP的诊断作用。然而，MRCP在检测微小胆管异常或小胆总管膨出方面能力有限。
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