原发性硬化性胆管炎的诊断：一项使用磁共振胆管造影和内镜逆行胆管造影的双盲对照研究。

Diagnosis of primary sclerosing cholangitis: a blinded comparative study using magnetic resonance cholangiography and endoscopic retrograde cholangiography.

作者信息

Moff Stephen L, Kamel Ihab R, Eustace Joseph, Lawler Leo P, Kantsevoy Sergey, Kalloo Anthony N, Thuluvath Paul J

机构信息

Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.

出版信息

Gastrointest Endosc. 2006 Aug;64(2):219-23. doi: 10.1016/j.gie.2005.12.034.

DOI:10.1016/j.gie.2005.12.034

PMID:16860072

Abstract

BACKGROUND

We hypothesized that magnetic resonance cholangiography (MRC) may have less accuracy for the diagnosis and the assessment of the severity of primary sclerosing cholangitis (PSC) than endoscopic retrograde cholangiography (ERC).

OBJECTIVE

The aim of this study was to determine the diagnostic accuracy and interobserver agreement of both ERC and MRC in PSC.

DESIGN

A case-control study.

SETTING

University Hospital.

PATIENTS

ERCs and MRCs of 36 patients with PSC and 51 controls (normal/other biliary tract diseases) were read in an independent, blinded, and random fashion by 2 magnetic resonance radiologists and 2 interventional endoscopists by using a previously validated classification system. Readers had no access to clinical history, laboratory results, or patient mix.

RESULTS

Extrahepatic ductal (EHD) and intrahepatic ductal (IHD) visualization was excellent in 64% of 66% of MRCs and 86% of 74% of ERCs. Sensitivity and specificity for diagnosis of PSC for readers 1 to 4 were 91% and 85%, 88% and 90%, 81% and 96%, and 83% and 96%. respectively. Receiver operating curve values were excellent for all readers (all >0.9). Interobserver agreement (kappa statistics) for the diagnosis of PSC (MRC, 0.83; ERC, 0.73) and for identifying the presence of IHD strictures (MRC, 0.64; ERC, 0.86) was good for both modalities, but only ERC (ERC, 0.55; MRC, 0.36) was good for the presence and the severity of EHD strictures. When assessment of disease severity was limited to the 36 patients with PSC, interobserver agreement was very poor for both MRC (0.23 and 0.07 for EHD and IHD, respectively) and ERC (0.24 and 0.34 for EHD and IHD, respectively).

LIMITATIONS

The retrospective case-control study made it difficult to assess the impact of the diagnosis on patient management.

CONCLUSIONS

ERC and MRC were comparable for diagnosing PSC, with very good interobserver agreement for the diagnosis of PSC and IHD strictures. Only ERC had good agreement for EHD strictures. Interobserver agreement was very poor for both MRC and ERC when disease severity of PSC was assessed.

摘要

背景

我们推测磁共振胆管造影（MRC）在原发性硬化性胆管炎（PSC）的诊断及严重程度评估方面的准确性可能低于内镜逆行胆管造影（ERC）。

目的

本研究旨在确定ERC和MRC对PSC的诊断准确性及观察者间的一致性。

设计

病例对照研究。

地点

大学医院。

患者

36例PSC患者及51例对照者（正常/其他胆道疾病）的ERC和MRC图像，由2名磁共振放射科医生和2名介入内镜医生采用先前验证的分类系统，以独立、盲法和随机的方式进行阅片。阅片者无法获取临床病史、实验室检查结果或患者组合情况。

结果

MRC中肝外胆管（EHD）和肝内胆管（IHD）显影良好的比例分别为64%和66%，ERC分别为86%和74%。读者1至4对PSC诊断的敏感性和特异性分别为91%和85%、88%和90%、81%和96%、83%和96%。所有读者的受试者工作特征曲线值均良好（均>0.9）。两种检查方式对于PSC诊断（MRC，0.83；ERC，0.73）及识别IHD狭窄的存在（MRC，0.64；ERC，0.86）的观察者间一致性良好，但仅ERC对于EHD狭窄的存在及严重程度的观察者间一致性良好（ERC，0.55；MRC，0.36）。当将疾病严重程度评估局限于36例PSC患者时，MRC（EHD和IHD分别为0.23和0.07）和ERC（EHD和IHD分别为0.24和0.34）的观察者间一致性均很差。