McMahon Colm J
Department of Radiology, St. Vincent's University Hospital, Dublin 4, Ireland.
Abdom Imaging. 2008 Jan-Feb;33(1):6-9. doi: 10.1007/s00261-007-9304-3.
The relative roles of magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS) in the investigation of common bile duct (CD) calculi were evaluated using "evidence-based practice" (EBP) methods.
A focused clinical question was constructed. A structured search of primary and secondary evidence was performed. Retrieved studies were appraised for validity, strength and level of evidence (Oxford/CEBM scale: 1-5). Retrieved literature was divided into group A; MRCP slice thickness >or=5 mm, group B; MRCP slice thickness = 3 mm or 3D-MRCP sequences.
Six studies were eligible for inclusion (3 = level 1b, 3 = level 3b). Group A: sensitivity and specificity of MRCP and EUS were (40%, 96%) and (80%, 95%), respectively. Group B: sensitivity and specificity of MRCP and EUS were (87%, 95%) and (90%, 99%), respectively.
MRCP should be the first-line investigation for CD calculi and EUS should be performed when MRCP is negative in patients with moderate or high pre-test probability.
采用“循证医学实践”（EBP）方法评估磁共振胰胆管造影（MRCP）和内镜超声（EUS）在胆总管结石检查中的相对作用。
构建一个重点临床问题。对一级和二级证据进行结构化检索。对检索到的研究进行有效性、强度和证据水平评估（牛津/循证医学中心量表：1 - 5级）。检索到的文献分为A组；MRCP层厚≥5mm，B组；MRCP层厚 = 3mm或三维MRCP序列。
六项研究符合纳入标准（3项 = 1b级，3项 = 3b级）。A组：MRCP和EUS的敏感性和特异性分别为（40%，96%）和（80%，95%）。B组：MRCP和EUS的敏感性和特异性分别为（87%，95%）和（90%，99%）。
MRCP应作为胆总管结石的一线检查方法，对于预测试验概率为中度或高度的患者，当MRCP结果为阴性时应进行EUS检查。
