Satiya Jinendra, Mousa Omar Y, Gupta Kapil, Trivedi Shivani, Oman Sven P, Wijarnpreecha Karn, Harnois Denise M, Corral Juan Enrique
Department of Internal Medicine, University of Miami/JFK Medical Center, West Palm Beach, FL, Unites States.
Department of Hepatology, Mayo Clinic, Rochester, MN, Unites States.
Clin Exp Hepatol. 2020 Feb;6(1):35-41. doi: 10.5114/ceh.2020.93054. Epub 2020 Feb 17.
Combined magnetic resonance imaging and magnetic resonance cholangiopancreatography (MRI/MRCP) can identify biliary strictures and diagnose primary sclerosing cholangitis (PSC). Diagnosis of cholangiocarcinoma in patients with PSC remains challenging, and the accuracy of MRI/MRCP has not been completely established. We aimed to determine the sensitivity and specificity of MRI/MRCP in the diagnosis of cholangiocarcinoma among patients with PSC from the published literature.
We searched Embase, PubMed, Cochrane, Scopus, ClinicalTrials.gov, and abstracts from relevant scientific meetings and performed a systematic review and meta-analysis to estimate the diagnostic yield of MRI/MRCP in patients with PSC. Sensitivity and specificity were calculated from pooled estimates of cholangiocarcinoma cases identified and lesions missed. Modifying variables were included in a meta-regression model.
Our literature search yielded 302 articles and 9 conference abstracts; 8 studies involving 846 liver patients from 5 countries were included in the final analysis. Of those, 531 had PSC and received MRI/MRCP. Thirty-six (6.8%) patients were diagnosed with cholangiocarcinoma (33 true positive, 3 false negative and 1 false positive). Pooled sensitivity was 98.9% (95% CI: 98.6-99.3%). Cholangiocarcinoma cases missed by MRI/MRCP were diagnosed as beading irregularities of the central hepatic ducts, or PSC-related diffuse stricture. Metaregression revealed that neither publication year, study design, nor sample size had a significant effect on observed cancer rates ( = 0.9, 0.3, and 0.3, respectively).
MRI/MRCP followed by endoscopic retrograde cholangiopancreatography (ERCP) is a sensitive and specific tool to diagnose cholangiocarcinoma among patients with PSC. Further research should estimate MRI/MRCP diagnostic accuracy for cholangiocarcinoma using prospective methodology and longer term outcomes.
磁共振成像与磁共振胰胆管造影（MRI/MRCP）相结合可识别胆管狭窄并诊断原发性硬化性胆管炎（PSC）。PSC患者胆管癌的诊断仍然具有挑战性，MRI/MRCP的准确性尚未完全确立。我们旨在从已发表的文献中确定MRI/MRCP在PSC患者胆管癌诊断中的敏感性和特异性。
我们检索了Embase、PubMed、Cochrane、Scopus、ClinicalTrials.gov以及相关科学会议的摘要，并进行了系统评价和荟萃分析，以评估MRI/MRCP在PSC患者中的诊断率。敏感性和特异性通过对已识别的胆管癌病例和漏诊病变的汇总估计来计算。修正变量纳入荟萃回归模型。
我们的文献检索共获得302篇文章和9篇会议摘要；最终分析纳入了来自5个国家的8项研究，涉及846例肝病患者。其中，531例患有PSC并接受了MRI/MRCP检查。36例（6.8%）患者被诊断为胆管癌（33例真阳性，3例假阴性，1例假阳性）。汇总敏感性为98.9%（95%CI：98.6 - 99.3%）。MRI/MRCP漏诊的胆管癌病例被诊断为肝中央胆管串珠样不规则或PSC相关的弥漫性狭窄。荟萃回归显示，发表年份、研究设计或样本量对观察到的癌症发生率均无显著影响（分别为 = 0.9、0.3和0.3）。
MRI/MRCP联合内镜逆行胰胆管造影（ERCP）是诊断PSC患者胆管癌的敏感且特异的工具。进一步的研究应采用前瞻性方法和长期结果来评估MRI/MRCP对胆管癌的诊断准确性。
