Weber C, Kuhlencordt R, Grotelueschen R, Wedegaertner U, Ang T L, Adam G, Soehendra N, Seitz U
Department of Diagnostic and Interventional Radiology, Diagnostic Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Endoscopy. 2008 Sep;40(9):739-45. doi: 10.1055/s-2008-1077509. Epub 2008 Aug 12.
Magnetic resonance cholangiopancreatography (MRCP) is a less-invasive alternative to endoscopic retrograde cholangiopancreatography (ERCP) for the diagnosis of primary sclerosing cholangitis (PSC). This study evaluated the diagnostic accuracy of MRCP in PSC compared with ERCP, and assessed the diagnostic accuracy of different T2w sequences.
95 patients (69 PSC, 26 controls) were evaluated using both ERCP and MRCP. Exclusion criteria included secondary sclerosing cholangitis and contraindications to MRCP. The diagnosis of PSC was confirmed in 69 patients based on ERCP as the reference gold standard. MRCP was performed using a 1.5 Tesla MR unit, using breath hold, coronal and transverse half-Fourier acquisition single-shot turbo spin-echo (HASTE), coronal-oblique, fat-suppressed half-Fourier rapid acquisition with relaxation enhancement (RARE), and coronal-oblique, fat-suppressed, multisection, thin-section HASTE (TS-HASTE) sequences. The MRCP morphological criteria of PSC were evaluated and compared with ERCP.
The sensitivity, specificity, and diagnostic accuracy were 86%, 77%, and 83%, respectively, using the MRCP-RARE sequence, and increased further to 93%, 77%, and 88%, respectively, by the inclusion of follow-up MRCP in 52 patients, performed at 6-12-month intervals. HASTE and TS-HASTE sequences showed significantly lower diagnostic accuracy but provided additional morphologic information.
MRCP can diagnose PSC but has difficulties in early PSC and in cirrhosis, and in the differentiation of cholangiocarcinoma, Caroli's disease, and secondary sclerosing cholangitis. A positive MRCP would negate some diagnostic ERCP studies but a negative MRCP would not obviate the need for ERCP.
磁共振胰胆管造影（MRCP）是一种用于诊断原发性硬化性胆管炎（PSC）的侵入性较小的替代内镜逆行胰胆管造影（ERCP）的方法。本研究评估了MRCP与ERCP相比在PSC诊断中的准确性，并评估了不同T2加权序列的诊断准确性。
对95例患者（69例PSC患者，26例对照）进行了ERCP和MRCP检查。排除标准包括继发性硬化性胆管炎和MRCP的禁忌证。以ERCP作为参考金标准，确诊69例PSC患者。使用1.5特斯拉磁共振设备进行MRCP检查，采用屏气、冠状位和横断位半傅里叶采集单次激发快速自旋回波（HASTE）序列、冠状斜位脂肪抑制半傅里叶快速采集弛豫增强（RARE）序列以及冠状斜位脂肪抑制多层面薄层HASTE（TS-HASTE）序列。评估了PSC的MRCP形态学标准并与ERCP进行比较。
使用MRCP-RARE序列时，敏感性、特异性和诊断准确性分别为86%、77%和83%，在52例患者中加入间隔6至12个月进行的随访MRCP后，分别进一步提高至93%、77%和88%。HASTE和TS-HASTE序列的诊断准确性显著较低，但提供了额外的形态学信息。
MRCP可诊断PSC，但在早期PSC、肝硬化以及胆管癌、卡罗利病和继发性硬化性胆管炎的鉴别诊断方面存在困难。MRCP阳性可否定一些诊断性ERCP检查，但MRCP阴性并不能排除ERCP检查的必要性。
