Hekimoglu Koray, Ustundag Yucel, Dusak Abdurrahim, Erdem Zuhal, Karademir Bulent, Aydemir Selim, Gundogdu Sadi
Department of Radiology, Karaelmas University, School of Medicine, Zonguldak, Turkey.
J Dig Dis. 2008 Aug;9(3):162-9. doi: 10.1111/j.1751-2980.2008.00339.x.
Recently developed magnetic resonance (MR) techniques permit fast and correct imaging of the entire biliary tree with a high spatial resolution. The aim of this study was to compare the diagnostic potential of one of these new MR sequences in magnetic resonance cholangiopancreatography (MRCP) procedure and endoscopic retrograde cholangiopancreatography (ERCP) with review of current literatures.
A total of 295 patients were enrolled in this study prospectively. Of these, 11 were excluded from the study due to inadequate MRCP image quality and 15 more were excluded due to unsuccessful cannulation during ERCP. Thus, finally 269 patients (124 men and 145 women with a mean age of 57 years; range: 23-92 years) were included. The MRCP procedure was performed before the ERCP in all cases. All MRCP studies were performed with recently developed new MR technique using a heavily T2-weighted turbo spin echo (TSE) sequence. This TSE sequence is currently one of the most widely used multiplanar 3-D MR technique, having a high spatial resolution and fast imaging capacity.
The study participants were classified into four main groups; normal into group I, stone disease into group II, tumor into group III and others into group IV. Group I consisted of 228 patients who had a normal pancreaticobiliary tree on both the MRCP and ERCP examinations. In group II there were 18 patients, for whom the MRCP had a 88.9% sensitivity and a 100% specificity for diagnosing biliary stone disease. Its positive predictive value (PPV), negative predictive value (NPV) and accuracy rates were 100%, 99.2% and 99.2%, respectively. The MRCP had a 100% sensitivity and a 100% specificity for 20 patients in group III. It also had 100% PPV, 100% NPV, and 100% total accuracy rates in this group. In three patients in group IV, the MRCP had a 100% sensitivity and specificity, respectively. Its PPV, NPV and accuracy were 100%, 100% and 100%, respectively.
MRCP is used with increasing frequency as a non-invasive alternative to ERCP and the diagnostic results of MRCP with a heavily T2-weighted TSE MR sequence and ERCP are comparable with high accuracy in various hepatobiliary pathologies.
最近开发的磁共振（MR）技术能够以高空间分辨率对整个胆管树进行快速且准确的成像。本研究的目的是通过回顾当前文献，比较磁共振胰胆管造影（MRCP）程序中这些新的MR序列之一与内镜逆行胰胆管造影（ERCP）的诊断潜力。
本研究前瞻性纳入了295例患者。其中，11例因MRCP图像质量不佳被排除在研究之外，另有15例因ERCP期间插管未成功被排除。因此，最终纳入了269例患者（124例男性和145例女性，平均年龄57岁；范围：23 - 92岁）。所有病例均先进行MRCP检查，然后进行ERCP。所有MRCP研究均采用最近开发的新MR技术，使用重T2加权快速自旋回波（TSE）序列。这种TSE序列是目前使用最广泛的多平面3D MR技术之一，具有高空间分辨率和快速成像能力。
研究参与者分为四个主要组；I组为正常组，II组为结石病组，III组为肿瘤组，IV组为其他组。I组由228例患者组成，其MRCP和ERCP检查均显示胰胆管树正常。II组有18例患者，MRCP对胆石病诊断的敏感性为88.9%，特异性为100%。其阳性预测值（PPV）、阴性预测值（NPV）和准确率分别为100%、99.2%和99.2%。MRCP对III组中的20例患者敏感性和特异性均为100%。该组的PPV、NPV和总准确率也均为100%。IV组中的3例患者，MRCP的敏感性和特异性分别为100%。其PPV、NPV和准确率分别为100%、100%和100%。
MRCP作为ERCP的非侵入性替代方法使用频率越来越高，在各种肝胆疾病中，采用重T2加权TSE MR序列的MRCP与ERCP的诊断结果具有高度可比性。
