Rahman Rubayat, Ju Justina, Shamma's John, Goebel Stephan, Sundaram Uma
Department of Medicine, WVU School of Medicine, Morgantown, USA.
W V Med J. 2010 Jul-Aug;106(5):14-9.
It is common clinical practice to obtain Magnetic Resonance Cholangiopancreatography (MRCP) prior to Endoscopic Retrograde Cholangiopancreatography (ERCP) to evaluate the biliary system. With recent improvements of MRCP, it is important to correlate the findings of these two studies.
To examine the correlation between MRCP and ERCP findings in patients at a tertiary care hospital.
A total of 165 patients were identified who underwent MRCP prior to ERCP at West Virginia University between July 1, 2004 and June 30, 2006 (98 females and 67 males). Patients' demographic information and their laboratory values and diagnostic study outcomes prior to procedure were collected, entered into MS Access, and analyzed using SAS 10.0. Sensitivity, specificity, positive predictive value and negative predictive value were calculated. Two-tailed p-values of <= 0.05 were considered statistically significant.
Baseline demographic characteristics were comparable between male and female patients. Hepatobiliary and pancreatic duct results were grouped together. MRCP was 74.6% sensitive and 83.5% specific for choledocholithiasis, 85.4% sensitive and 87.4% specific for strictures, 85.9% sensitive and 91.2% specific for obstruction, 92.4% sensitive and 93.5% specific for ductal dilatation, and 90.8% sensitive and 92.6% specific for detection of periductal masses. MRCP appeared to have more false negative results for choledocholithiasis and strictures and more false positive results for ductal dilatation and periductal mass detection compared with ERCP.
In patients with presentations suggestive of hepatobiliary and pancreatic disease, despite recent improvements in MRCP technique, the sensitivity and specificity of MRCP is still not close enough to that of ERCP for detection of choledocholithiasis, hepatobiliary and pancreatic ductal dilatation, periductal masses, or obstruction to be used as a substitute. Thus, ERCP remains the gold standard for visualization of the hepatobiliary and pancreatic tree.
在内镜逆行胰胆管造影术（ERCP）之前进行磁共振胰胆管造影（MRCP）以评估胆道系统是常见的临床操作。随着MRCP技术的不断改进，对比这两项检查的结果具有重要意义。
在一家三级护理医院中，研究患者的MRCP与ERCP检查结果之间的相关性。
共有165例患者于2004年7月1日至2006年6月30日期间在西弗吉尼亚大学接受了先MRCP后ERCP的检查（其中女性98例，男性67例）。收集患者的人口统计学信息、术前实验室检查值及诊断性检查结果，录入微软Access数据库，并使用SAS 10.0进行分析。计算敏感性、特异性、阳性预测值和阴性预测值。双侧p值≤0.05被视为具有统计学意义。
男性和女性患者的基线人口统计学特征具有可比性。将肝胆管和胰管检查结果合并统计。MRCP对胆总管结石的敏感性为74.6%，特异性为83.5%；对狭窄的敏感性为85.4%，特异性为87.4%；对梗阻的敏感性为85.9%，特异性为91.2%；对胆管扩张的敏感性为92.4%，特异性为93.5%；对检测胆管周围肿块的敏感性为90.8%，特异性为92.6%。与ERCP相比，MRCP对胆总管结石和狭窄的假阴性结果较多，对胆管扩张和胆管周围肿块检测的假阳性结果较多。
在提示肝胆胰疾病的患者中，尽管MRCP技术近期有所改进，但在检测胆总管结石、肝胆胰管扩张、胆管周围肿块或梗阻方面，MRCP的敏感性和特异性仍与ERCP相差较大，不足以替代ERCP。因此，ERCP仍然是可视化肝胆胰管系统的金标准。
