Berstad Audun Elnaes, Aabakken Lars, Smith Hans-Jørgen, Aasen Steinar, Boberg Kirsten Muri, Schrumpf Erik
Department of Radiology, Section of Gastroenterology, Rikshospitalet University Hospital, Oslo, Norway.
Clin Gastroenterol Hepatol. 2006 Apr;4(4):514-20. doi: 10.1016/j.cgh.2005.10.007.
BACKGROUND & AIMS: To evaluate the accuracy and interobserver variability of magnetic resonance cholangiography (MRC) and endoscopic retrograde cholangiography (ERC) in the diagnosis of primary sclerosing cholangitis (PSC).
MRC at 1.5 T with thin- and thick-slice breath-hold technique was performed in 66 adult patients (median age, 44 y; 26 women) with an appropriate spectrum of hepatobiliary diseases. Maximum intensity projection images were reconstructed from the thin slices. ERC was performed within 48 hours of the MR examination. The reference standard of PSC diagnosis was based on a combination of clinical features and cholestatic biochemical profile with typical ERC and/or MRC abnormalities and supported by liver histology findings. Two independent reviewers who were unaware of final diagnoses analyzed all images retrospectively.
PSC was diagnosed in 39 (59%) of 66 patients. MRC provided comparable and poorer depiction than ERC of extrahepatic and intrahepatic ducts, respectively. However, the diagnostic accuracy of ERC and MRC were comparable. In the MRC detection of PSC, the average sensitivity of 2 independent readers was 80%, the specificity was 87%, and the accuracy was 83%. The corresponding values for ERC were a sensitivity of 89%, a specificity of 80%, and an accuracy of 85%. Interobserver agreement for the diagnosis of PSC was good (kappa = .61) for MRC and excellent (kappa = .81) for ERC.
PSC can be diagnosed with high accuracy and good interobserver agreement. MRC and ERC performed equally well in the diagnosis of PSC when used blinded to clinical information.
评估磁共振胰胆管造影（MRC）和内镜逆行胰胆管造影（ERC）在原发性硬化性胆管炎（PSC）诊断中的准确性及观察者间的变异性。
对66例患有各种肝胆疾病的成年患者（中位年龄44岁；26名女性）进行1.5T的MRC检查，采用薄层和厚层屏气技术。从薄层图像重建最大强度投影图像。在MR检查后48小时内进行ERC。PSC诊断的参考标准基于临床特征、胆汁淤积生化指标以及典型的ERC和/或MRC异常，并得到肝脏组织学结果的支持。两名不知最终诊断结果的独立观察者对所有图像进行回顾性分析。
66例患者中有39例（59%）被诊断为PSC。MRC对肝外胆管和肝内胆管的显示分别与ERC相当但较差。然而，ERC和MRC的诊断准确性相当。在MRC检测PSC时，两名独立观察者的平均敏感性为80%，特异性为87%，准确性为83%。ERC的相应值为敏感性89%，特异性80%，准确性85%。观察者间对PSC诊断的一致性，MRC为良好（kappa = 0.61），ERC为优秀（kappa = 0.81）。
PSC能够以高准确性和良好的观察者间一致性进行诊断。当对临床信息不知情时，MRC和ERC在PSC诊断中的表现同样良好。
