Kamisawa T, Tu Y, Egawa N, Tsuruta K, Okamoto A, Kamata N
Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo 113-8677, Japan.
Abdom Imaging. 2007 Jan-Feb;32(1):129-33. doi: 10.1007/s00261-006-9005-3.
Congenital pancreaticobiliary malformations are sometimes associated with acute or chronic pancreatitis and biliary carcinoma. Currently, magnetic resonance cholangiopancreatography (MRCP) is one of the first choices for investigating and diagnosing pancreaticobiliary diseases noninvasively. We compared the accuracy of conventional MRCP and endoscopic retrograde cholangiopancreatography (ERCP) in making the diagnosis of congenital pancreaticobiliary malformations.
In patients with pancreas divisum (n = 17), pancreaticobiliary maljunction (n = 12), choledochocele (n = 2), and annular pancreas (n = 1) who underwent ERCP and MRCP, the diagnostic accuracy and findings on MRCP were compared with those on ERCP.
Of the 32 patients with congenital pancreaticobiliary malformations diagnosed on ERCP, 23 (72%) presented the same diagnosis on MRCP. Complete pancreas divisum was diagnosed in 73% on MRCP based on the finding of a dominant dorsal pancreatic duct crossing the lower bile duct and emptying into the duodenum without communicating with the ventral pancreatic duct. Pancreaticobiliary maljunction was diagnosed in 75% on MRCP based on the finding of an anomalous union between the common bile duct and the pancreatic duct and the existence of a long common channel.
Conventional MRCP is a useful, noninvasive tool for diagnosing congenital pancreaticobiliary malformations; and the diagnostic accuracy can be increased with three-dimensional MRCP or dynamic MRCP with secretin stimulation.
先天性胰胆管畸形有时与急性或慢性胰腺炎及胆管癌相关。目前，磁共振胰胆管造影（MRCP）是无创性检查和诊断胰胆管疾病的首选方法之一。我们比较了传统MRCP和内镜逆行胰胆管造影（ERCP）在诊断先天性胰胆管畸形方面的准确性。
对17例胰腺分裂症、12例胰胆管合流异常、2例胆总管囊肿和1例环状胰腺患者进行了ERCP和MRCP检查，比较了MRCP与ERCP的诊断准确性及检查结果。
在ERCP诊断为先天性胰胆管畸形的32例患者中，23例（72%）在MRCP上得到相同诊断。基于优势背侧胰管穿过低位胆管并汇入十二指肠且不与腹侧胰管相通的表现，MRCP对完全性胰腺分裂症的诊断率为73%。基于胆总管与胰管异常汇合及存在长共同通道的表现，MRCP对胰胆管合流异常的诊断率为75%。
传统MRCP是诊断先天性胰胆管畸形的一种有用的无创工具；三维MRCP或使用促胰液素刺激的动态MRCP可提高诊断准确性。
