Kim Jin Hee, Kim Myung-Hwan, Byun Jae Ho, Lee Seung Soo, Lee So Jung, Park Seong Ho, Lee Sung Koo, Park Do Hyun, Lee Moon-Gyu, Moon Sung-Hoon
From the Departments of *Radiology and Research Institute of Radiology and †Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul; and ‡Department of Internal Medicine, Dankook University Hospital, Cheonan, South Korea.
Pancreas. 2012 May;41(4):639-647. doi: 10.1097/MPA.0b013e31823a509b. Epub 2012 Jan 5.
The purpose of this study was to determine whether the choice for performance of endoscopic retrograde pancreatography (ERP) could be tailored to findings on computed tomography (CT) in patients with suspected autoimmune pancreatitis (AIP). METHODS: Eighty-four AIP patients and 73 pathology-proven pancreatic cancer patients from a prospectively maintained database were retrospectively included. Computed tomography and ERP images were reviewed in consensus by 2 blinded radiologists. The diagnostic performance of CT alone and combined use of CT and ERP (CT-ERP) were compared. RESULTS: The area under the receiver operating characteristic curve of CT-ERP was significantly greater than that of CT alone (0.97 vs 0.87, P < 0.001). When patients with AIP were divided into 2 subgroups according to CT features (typical vs atypical), 24 (69%) of 35 AIP patients with atypical CT findings were correctly diagnosed with AIP at CT-ERP and received benefits from additional ERP. Endoscopic retrograde pancreatography had little added benefit in patients with typical CT findings for AIP (n = 49), because no alternative diagnoses were established after ERP. CONCLUSIONS: In patients with suspected AIP, the decision to perform ERP could be tailored to findings on CT.
本研究旨在确定对于疑似自身免疫性胰腺炎（AIP）的患者，内镜逆行胰胆管造影（ERP）的实施选择是否可根据计算机断层扫描（CT）结果进行调整。方法：回顾性纳入来自前瞻性维护数据库的84例AIP患者和73例经病理证实的胰腺癌患者。由2名 blinded 放射科医生共同回顾CT和ERP图像。比较单独使用CT以及联合使用CT和ERP（CT-ERP）的诊断性能。结果：CT-ERP的受试者操作特征曲线下面积显著大于单独使用CT（0.97对0.87，P<0.001）。当根据CT特征将AIP患者分为2个亚组（典型组与非典型组）时，35例具有非典型CT表现的AIP患者中有24例（69%）在CT-ERP时被正确诊断为AIP，并从额外的ERP中获益。对于具有典型AIP CT表现的患者（n = 49），ERP几乎没有额外益处，因为ERP后未确立其他诊断。结论：对于疑似AIP的患者，ERP的实施决策可根据CT结果进行调整。
