磁共振胰胆管成像与内镜逆行胰胆管造影在胆总管结石诊断中的前瞻性对比研究。

Magnetic resonance cholangio-pancreatography versus endoscopic retrograde cholangio-pancreatography in the diagnosis of common bile duct stones: a prospective comparative study.

机构信息

Department of Medicine and Pharmacology, University of Messina, Messina, Italy.

出版信息

Minerva Med. 2009 Oct;100(5):341-8.

PMID:19910887

Abstract

AIM

As it is a non-invasive method, magnetic resonance cholangiography (MRCP) has almost completely replaced endoscopic retrograde cholangiography (ERCP) in the diagnosis of pancreato-biliary diseases. The aim of this study was to evaluate sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV) and negative predictive value (NPV) of MRCP in diagnosis of choledocholithiasis using ERCP/endoscopic sphincterotomy (ES) as gold standard.

METHODS

For this study 140 individuals, suspected for lithiasis of the common bile duct (CBD), were enrolled. After a clinical and biochemical evaluation, patients underwent upper abdominal ultrasonography, then MRCP and diagnostic and/or operative ERCP.

RESULTS

Only 120 out of 140 patients completed the study. MRCP diagnosed lithiasis of CBD in 84. ERCP confirmed the lithiasis in 73/84 patients who were submitted to ES. Eleven were negative after ES. ERCP documented stones in 10 patients among the 36 negative at MRCP; stones were detected only in four patients after ES. In 26 out of 36 patients negative at MRCP, ERCP confirmed this response: only 12 out of 26 patients underwent ES. The sensitivity, specificity, diagnostic accuracy, PPV and NPV of MRCP were: 88%, 72%, 83%, 87%, 72%.

CONCLUSIONS

As the MRCP diagnostic yield is still limited with small stones, the question of which patient is the best candidate to ERCP/ES is still unsolved.

摘要

目的

磁共振胆胰管成像（MRCP）作为一种非侵入性方法，在胰胆管疾病的诊断中几乎完全取代了内镜逆行胰胆管造影（ERCP）。本研究旨在评估 MRCP 诊断胆总管结石的敏感性、特异性、诊断准确性、阳性预测值（PPV）和阴性预测值（NPV），以 ERCP/内镜括约肌切开术（ES）为金标准。

方法

本研究纳入了 140 名疑似胆总管结石（CBD）的患者。在进行临床和生化评估后，患者接受了上腹部超声检查，然后进行了 MRCP 和诊断性或手术性 ERCP。

结果

只有 140 名患者中的 120 名完成了研究。MRCP 诊断 CBD 结石 84 例。在接受 ES 的 73/84 例患者中，ERCP 证实了结石。11 例 ES 后为阴性。在 36 例 MRCP 阴性的 10 例患者中，ERCP 发现了结石；在 4 例患者中仅在 ES 后发现了结石。在 26 例 MRCP 阴性的患者中，ERCP 证实了这一结果：只有 12 例患者接受了 ES。MRCP 的敏感性、特异性、诊断准确性、PPV 和 NPV 分别为 88%、72%、83%、87%和 72%。