Indiana University Medical Center, Indianapolis, IN, USA.
Dig Dis Sci. 2012 Jan;57(1):170-4. doi: 10.1007/s10620-011-1823-7. Epub 2011 Jul 15.
Patients with pancreas divisum may develop pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for diagnosing pancreas divisum. Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive test reported to be highly accurate in diagnosing pancreas divisum.
To evaluate the diagnostic accuracy of MRCP in detecting pancreas divisum at our institution.
We reviewed patients who underwent both ERCP and MRCP. Patients who had diagnostic endoscopic pancreatograms (ERP) after MRCP comprise the study population. Secretin was given in 113/146 patients (S-MRCP). The remaining 33/146 patients had MRCP without secretin. In 7/33 patients who underwent MRCP without secretin (21.2%), the studies were non-diagnostic and, therefore, this group was not further analyzed and the study focused on the S-MRCP group only.
ERP identified pancreas divisum in 19/113 (16.8%) patients. S-MRCP identified 14/19 pancreas divisum and was false-positive in three cases (sensitivity 73.3%, specificity 96.8%, positive predictive value 82.4%, negative predictive value 94.8%). Of the eight patients with inaccurate S-MRCP, 5 (63%) had changes of chronic pancreatitis by ERP. This differs from the frequency of chronic pancreatitis by ERP in 24/105 (23%) patients with accurate MRCP findings. The ERCP findings of chronic pancreatitis were more frequent among incorrect S-MRCP interpretations than among correct interpretations (odds ratio [OR] 5.5 [95% confidence interval (CI) 1.3-25.3]). MRCP without secretin is non-diagnostic for pancreas divisum in a significant proportion of patients. S-MRCP had a satisfactory specificity for detecting pancreas divisum. However, the sensitivity of S-MRCP for the diagnosis of pancreas divisum was modest at 73.3%. This is low compared to previous smaller studies, which reported a sensitivity of MRCP of up to 100%.
胰腺分裂症患者可能会发生胰腺炎。内镜逆行胰胆管造影（ERCP）是诊断胰腺分裂症的金标准。磁共振胰胆管成像（MRCP）是一种非侵入性检查方法，据报道其在诊断胰腺分裂症方面具有高度准确性。
评估我院 MRCP 诊断胰腺分裂症的准确性。
我们回顾了同时接受 ERCP 和 MRCP 的患者。MRCP 后进行诊断性内镜胰管造影（ERP）的患者构成了研究人群。在 113/146 例患者中给予了促胰液素（S-MRCP）。其余 33/146 例患者未给予促胰液素进行 MRCP。在 33/7 例未给予促胰液素进行 MRCP 的患者中（21.2%），研究结果无诊断意义，因此，这组患者未进一步分析，研究仅关注 S-MRCP 组。
ERP 在 19/113（16.8%）例患者中识别出胰腺分裂症。S-MRCP 识别出 14/19 例胰腺分裂症，在 3 例中呈假阳性（敏感性 73.3%，特异性 96.8%，阳性预测值 82.4%，阴性预测值 94.8%）。在 8 例 S-MRCP 结果不准确的患者中，有 5 例（63%）ERP 显示慢性胰腺炎改变。这与在 24/105（23%）ERP 检查结果准确的患者中慢性胰腺炎的发生率不同。在不正确的 S-MRCP 解释中，慢性胰腺炎的 ERCP 发现比正确的解释更常见（比值比[OR]5.5[95%置信区间（CI）1.3-25.3]）。在相当一部分患者中，无促胰液素的 MRCP 对胰腺分裂症的诊断无诊断意义。S-MRCP 对胰腺分裂症的特异性较高。然而，S-MRCP 诊断胰腺分裂症的敏感性适中，为 73.3%。与之前报道的高达 100%的 MRCP 敏感性的较小研究相比，这一比例较低。
