Calle G, Hastier P, Chevalier P, Bataille L, Dumas R, Demarquai J F, Rampal P
Hospital Universitario del Río, Facultade de Medicina de la Universidad del Azuay, Cuenca, Ecuador.
Rev Gastroenterol Peru. 2006 Apr-Jun;26(2):115-24.
To evaluate the diagnostic efficiency of the magnetic resonance cholangiography (MRC) in the detection of main bile duct stones in a set of 102 patients.
Criteria of inclusion were: Clinic and biological suspicion of biliary stones obstruction with exams of first intention no contributive. We used the "turbo spin echo" sequences with thick slices in single shot mode and fine slides with reconstruction in 3D by a computer. Exams of reference were the endoscopic retrograde cholangiography (76.47%), an intraoperative cholangiography (20.59%) and a per-cutaneous cholangiography (2.94%).
Stones of the main bile duct have been diagnosed at thirty-five patient (35.7%); we had 3 positive forgeries and 6 negative forgeries of the MRC. The sensitivity was 82,9%, the specificity of 95,5%, the positive predictive value and the negative predictive value were, respectively, of 90,6% and 91,4%. The observant variance test was excellent (kappa = 0.83). Mistakes of diagnosis of the MRC were bound to: stones less than 3 mms with a bile duct no dilated, malignant stenosis, structural details as the presence of a duodenal diverticula's or severe duodenitis and a certain difficulty to see the sphincter complex.
Performances of the CIRM was good, and only in very particular cases, it was the origin of confusions.
为评估磁共振胆胰管造影（MRC）对102例患者主胆管结石的诊断效能。
纳入标准为：临床和生物学怀疑有胆管结石梗阻，而初次检查无诊断价值。我们使用单次激发模式下的厚层“快速自旋回波”序列以及计算机三维重建的薄层序列。参考检查为内镜逆行胰胆管造影（76.47%）、术中胆管造影（20.59%）和经皮胆管造影（2.94%）。
35例患者（35.7%）诊断为主胆管结石；MRC有3例假阳性和6例假阴性。敏感性为82.9%，特异性为95.5%，阳性预测值和阴性预测值分别为90.6%和91.4%。一致性检验结果良好（kappa = 0.83）。MRC的诊断错误与以下情况有关：胆管未扩张时小于3毫米的结石、恶性狭窄、十二指肠憩室或严重十二指肠炎症等结构细节以及观察括约肌复合体存在一定困难。
MRC的性能良好，仅在非常特殊的情况下会导致混淆。
