Department of Pediatric Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
J Pediatr Surg. 2011 Jul;46(7):1373-8. doi: 10.1016/j.jpedsurg.2011.01.026.
BACKGROUND/PURPOSE: The aim of this study was to investigate the diagnostic potential of computed tomography cholangiography (CTC) and magnetic resonance cholangiopancreatography (MRCP) in children with pancreaticobiliary maljunction (PBM).
Fifty-three children with PBM were consecutively treated between 1997 and 2009. Among them, the patients who underwent CTC and/or MRCP preoperatively were enrolled in this study. Computed tomography cholangiography was examined after infusion of meglumine iodoxamate with subsequent 3-dimensional rendering. The visualization of the biliary and pancreatic duct systems was evaluated and compared with that visualized with MRCP. The findings of direct cholangiography were used as the standard of reference.
Of the 53 cases with PBM, 17 cases were examined by CTC, 10 cases by MRCP, and 17 with both. The extrahepatic bile tract was visualized in 32 (94.1%) of 34 patients in CTC and in all 27 patients in MRCP. The intrahepatic bile duct was more frequently demonstrated by MRCP than by CTC (96.3% vs 70.6%, P = .02). Pancreaticobiliary maljunction was noted in 13 (38.2%) of 34 with CTC and in 12 (44.4%) of 27 with MRCP. The minimum age for visualization of PBM was at 10 months in CTC and at 1 year and 11 months in MRCP, respectively. The main pancreatic duct was more frequently visualized by MRCP than by CTC (81.5% vs 8.8%, P < .001).
Magnetic resonance cholangiopancreatography provides superior visualization of the intrahepatic duct and the pancreatic system when compared with CTC. However, it is still challenging to perform a good-quality examination in young infant. The great advantage of CTC is its ability to produce high-quality images without respiratory artifacts and that it allows accurate assessment of the presence of PBM equivalent to MRCP.
背景/目的：本研究旨在探讨 CT 胆系造影（CTC）和磁共振胆胰管成像（MRCP）在儿童胰胆管合流异常（PBM）中的诊断价值。
1997 年至 2009 年，连续收治 53 例 PBM 患儿。本研究纳入了术前接受 CTC 和/或 MRCP 检查的患者。经碘海醇静脉滴注后行 CTC 检查，并行三维重建。评估并比较胆管和胰管系统的显示情况，将直接胆管造影的结果作为参考标准。
53 例 PBM 患儿中，17 例行 CTC 检查，10 例行 MRCP 检查，17 例行两者检查。34 例患者中，32 例（94.1%）在 CTC 中显示了肝外胆管，27 例患者在 MRCP 中均显示了肝外胆管。MRCP 比 CTC 更能显示肝内胆管（96.3% vs 70.6%，P =.02）。13 例（38.2%）患者在 CTC 中显示胰胆管合流异常，12 例（44.4%）患者在 MRCP 中显示胰胆管合流异常。CTC 显示 PBM 的最小年龄为 10 个月，MRCP 为 1 岁 11 个月。MRCP 比 CTC 更能显示主胰管（81.5% vs 8.8%，P <.001）。
与 CTC 相比，MRCP 能更好地显示肝内胆管和胰管系统。然而，在婴儿期进行高质量的检查仍然具有挑战性。CTC 的一大优势是能够在没有呼吸伪影的情况下生成高质量的图像，并且能够准确评估 PBM 的存在，与 MRCP 相当。
