Department of Clinical and Experimental Medicine, Pediatric Gastroenterology, University of Pisa, Pisa, Italy.
Clin Res Hepatol Gastroenterol. 2013 Dec;37(6):596-601. doi: 10.1016/j.clinre.2013.05.014. Epub 2013 Jul 3.
Magnetic resonance cholangiography (MRC) has been validated as comparable to endoscopic retrograde cholangiography (ERC) for the diagnosis of sclerosing cholangitis (SC) in adult patients. In children, MRC is widely used based mainly on non-comparative studies.
ERCs and MRCs of seven children (median age 9, range: 7-20 years) with SC and 17 controls (median age 6, range: 2 months-20 years) with other chronic liver diseases were reviewed in a blinded, random and independent way. All patients underwent both examinations within a 6-months slot. All ERCs and 17 MRCs were performed under general anesthesia. One radiologist evaluated both ERCs and MRCs and one interventional endoscopist independently reviewed only ERCs. Reviewers did not receive any clinical information. Diagnosis of SC, established on the basis of history, laboratory data, radiological examinations and clinical course, was used as gold standard to compare ERC and MRC diagnostic accuracy.
Overall image quality was graded as very good in 57% of MRC and in 71% of ERC cases; difference was not statistically significant (P=0.24) although the probability for MRC to be diagnostic increased with patient's age. Depiction of first, second and fourth-order intrahepatic bile duct was better in ERC (P=0.004, 0.02 and 0.023, respectively); depiction of the extrahepatic bile duct was comparable (P=0.052). Diagnostic accuracy of MRC and ERC was very high, without statistically significant difference (P=0.61).
Despite an overall better depiction of the biliary tree by ERC, MRC is comparable for the diagnosis of SC in children. These data support MRC as the first imaging approach in children with suspected SC.
磁共振胆胰管成像（MRC）已被验证可与内镜逆行胰胆管造影（ERC）相媲美，用于诊断成人硬化性胆管炎（SC）。在儿童中，MRC 主要基于非对照研究而被广泛应用。
我们以盲法、随机和独立的方式回顾性分析了 7 例 SC 患儿（中位年龄 9 岁，范围：7-20 岁）和 17 例其他慢性肝病患儿（中位年龄 6 岁，范围：2 个月-20 岁）的 ERC 和 MRC。所有患者均在 6 个月的时间窗内同时接受了这两种检查。所有 ERC 和 17 次 MRC 均在全身麻醉下进行。一位放射科医生评估了所有的 ERC 和 MRC，一位介入内镜医生则仅独立地评估了 ERC。评估者没有收到任何临床信息。SC 的诊断是基于病史、实验室数据、影像学检查和临床病程，作为比较 ERC 和 MRC 诊断准确性的金标准。
总体而言，MRC 的图像质量评分非常好的比例为 57%，ERC 为 71%；差异无统计学意义（P=0.24），尽管 MRC 的诊断概率随着患者年龄的增长而增加。ERC 对一级、二级和四级肝内胆管的显示优于 MRC（P=0.004、0.02 和 0.023）；对肝外胆管的显示则相似（P=0.052）。MRC 和 ERC 的诊断准确性均非常高，差异无统计学意义（P=0.61）。
尽管 ERC 对胆道的总体显示更好，但 MRC 对儿童 SC 的诊断具有可比性。这些数据支持 MRC 作为怀疑患有 SC 的儿童的首选影像学方法。
