Sandrasegaran Kumaresan, Cote Gregory A, Tahir Bilal, Ahmad Iftikhar, Tann Mark, Akisik Fatih M, Lall Chandana G, Sherman Stuart
Department of Radiology, 550 N University Blvd, UH 0279, Indianapolis, IN, 46202, USA,
Abdom Imaging. 2014 Oct;39(5):979-87. doi: 10.1007/s00261-014-0131-z.
To assess the additional value of secretin-enhanced MRCP (SMRCP) over conventional MRCP in diagnosing divisum.
Retrospective HIPAA-compliant and IRB-approved review found 140 patients with SMRCP and ERCP correlation within 6 months of each other. All studies were anonymized and the SMRCP images (SMRCP image set) were separated from 2D and 3D MRCP and axial and coronal T2-weighted images (conventional MRI image set). Each image set on each patient was assigned different and randomized case numbers. Two reviewers (R1 and R2) independently reviewed the image sets for divisum vs. no divisum, complete divisum vs. incomplete divisum, and the certainty of diagnosis (1 = definitely certain, 2 = moderately certain, and 3 = unsure). ERCP findings were taken as gold standard.
There was no difference in age and gender between the divisum (n = 97, with 13 incomplete divisum) and no divisum (n = 43) groups. In diagnosing divisum anatomy, the sensitivity was higher for SMRCP compared to conventional MRI for R1 (84.5 vs. 72.2, p = 0.02) but not R2 (89.7 vs. 84.4, p = 0.25). The specificity was higher in SMRCP image set compared to conventional MRI (R1: 88.1 vs. 76.2, p = 0.01; R2: 81.4 vs. 65.1, p < 0.001). The mean area under ROC curve was higher for SMRCP image set (R1: 0.86 vs. 0.74, p = 0.01; R2: 0.87 vs. 0.74, p = 0.01). The certainty of diagnosis was higher in SMRCP image set compared to conventional MRI (p = 0.02 for both reviewers). SMRCP was not found to be superior in distinguishing incomplete from complete divisum. The main reasons for erroneous SMRCP diagnosis were the presence of an ansa loop in the main duct and ductal strictures due to chronic pancreatitis.
Even though the reviewers had more sequences (axial and coronal) to evaluate in the non-secretin image set, there was some improvement in diagnosing divisum with SMRCP.
评估促胰液素增强磁共振胰胆管造影（SMRCP）相较于传统磁共振胰胆管造影（MRCP）在诊断胰腺分裂症方面的附加价值。
经符合HIPAA规定且经机构审查委员会（IRB）批准的回顾性研究，发现140例患者在彼此6个月内接受了SMRCP和内镜逆行胰胆管造影（ERCP）检查。所有研究均进行了匿名处理，且SMRCP图像（SMRCP图像集）与二维和三维MRCP以及轴位和冠状位T2加权图像（传统MRI图像集）分开。为每位患者的每个图像集分配了不同的随机病例编号。两位阅片者（R1和R2）独立对图像集进行评估，判断是否存在胰腺分裂症、完全性胰腺分裂症与不完全性胰腺分裂症，以及诊断的确定性（1 = 绝对确定，2 = 中度确定，3 = 不确定）。以ERCP检查结果作为金标准。
胰腺分裂症组（n = 97，其中13例为不完全性胰腺分裂症）和无胰腺分裂症组（n = 43）在年龄和性别上无差异。在诊断胰腺分裂症解剖结构方面，R1认为SMRCP的敏感性高于传统MRI（84.5对72.2，p = 0.02），但R2未发现此差异（89.7对84.4，p = 0.25）。与传统MRI相比，SMRCP图像集的特异性更高（R1：88.1对76.2，p = 0.01；R2：81.4对65.1，p < 0.001）。SMRCP图像集的ROC曲线下平均面积更高（RIA：0.86对0.74，p = 0.01；R2：0.87对0.74，p = 0.01）。与传统MRI相比，SMRCP图像集的诊断确定性更高（两位阅片者的p值均为0.02）。未发现SMRCP在区分不完全性与完全性胰腺分裂症方面更具优势。SMRCP诊断错误的主要原因是主胰管存在袢环以及慢性胰腺炎导致的胰管狭窄。
尽管阅片者在非促胰液素图像集中有更多序列（轴位和冠状位）需要评估，但SMRCP在诊断胰腺分裂症方面仍有一定改善。
