胰管膨出：磁共振胰胆管造影评估及临床意义

Wirsungocele: evaluation by MRCP and clinical significance.

作者信息

Evrimler Sehnaz, Swensson Jordan K, Soufi Mazhar, Tirkes Temel, Schmidt C Max, Akisik Fatih

机构信息

Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd Room 0663, Indianapolis, IN, 46202, USA.

Department of Radiology, Suleyman Demirel University School of Medicine, East Campus, Cunur, 32260, Isparta, Turkey.

出版信息

Abdom Radiol (NY). 2021 Feb;46(2):616-622. doi: 10.1007/s00261-020-02675-4. Epub 2020 Jul 31.

DOI:10.1007/s00261-020-02675-4

PMID:32737547

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7987211/

Abstract

PURPOSE

Wirsungocele is a rare cystic dilatation of the main pancreatic duct seen at the terminal portion of the duct of Wirsung. The purpose of our study is to evaluate the diagnostic value of MRCP in detection of Wirsungocele and the association between the MRCP-determined size of Wirsungocele and the MRCP-clinical findings of pancreatitis.

METHODS

Thirty-four patients with reported 'Wirsungocele' were analyzed in the study. Two radiologists reviewed MRCP/S-MRCP images for the presence and diameter of Wirsungocele (WD), main pancreatic duct dilatation (MPDD), side branch ectasia (SBE), acinarization, and duodenal filling grade. Electronic medical record review included symptoms (abdominal pain), signs (recurrent acute/chronic pancreatitis), and select laboratory testing (serum amylase and lipase). Inter-reader agreement values were calculated by ICC. Pearson correlation analysis was performed to evaluate the association of WD with radiological and clinical findings. The comparison of WD on MRCP versus S-MRCP was calculated by Wilcoxon test. Mann-Whitney U test was used for two independent variable comparisons.

RESULTS

The sensitivity of MRCP for the detection of Wirsungocele calculated using the S-MRCP and ERCP as the reference method was 76.9% and 100%, respectively. There was a significant difference in the diameter of Wirsungocele measured by MRCP vs S-MRCP (p < 0.001). There was good inter-reader agreement for the detection of Wirsungocele on MRCP and measurement of WD on MRCP and S-MRCP (ICC: 0.79, 0.89, and 0.80, respectively, p < 0.001). There was a significant difference in WD between the patients with and without MPDD (p < 0.05). There was a significant positive correlation between WD and MPDD (r = 0.66, p < 0.05). WD was significantly associated with recurrent acute pancreatitis (p < 0.05).

CONCLUSION

MRCP is a highly sensitive and non-invasive imaging tool for detection of Wirsungocele. Greater Wirsungocele diameter is associated with MPDD and recurrent acute pancreatitis.

摘要

目的

胰腺主胰管囊肿是一种罕见的胰腺主胰管囊性扩张，见于主胰管末端。本研究的目的是评估磁共振胰胆管造影（MRCP）在检测胰腺主胰管囊肿中的诊断价值，以及MRCP测定的胰腺主胰管囊肿大小与胰腺炎的MRCP临床发现之间的关联。

方法

本研究分析了34例报告有“胰腺主胰管囊肿”的患者。两名放射科医生对MRCP/S-MRCP图像进行了检查，以确定是否存在胰腺主胰管囊肿（WD）、主胰管扩张（MPDD）、分支胰管扩张（SBE）、腺泡化和十二指肠充盈程度。电子病历审查包括症状（腹痛）、体征（复发性急性/慢性胰腺炎）和特定实验室检查（血清淀粉酶和脂肪酶）。通过组内相关系数（ICC）计算阅片者间一致性值。进行Pearson相关分析以评估WD与影像学和临床发现之间的关联。通过Wilcoxon检验计算MRCP与S-MRCP上WD的差异。使用Mann-Whitney U检验进行两个独立变量的比较。

结果

以S-MRCP和内镜逆行胰胆管造影（ERCP）作为参考方法计算，MRCP检测胰腺主胰管囊肿的敏感性分别为76.9%和100%。MRCP与S-MRCP测量的胰腺主胰管囊肿直径存在显著差异（p<0.001）。在MRCP上检测胰腺主胰管囊肿以及在MRCP和S-MRCP上测量WD方面，阅片者间具有良好的一致性（ICC分别为0.79、0.89和0.80，p<0.001）。有和没有MPDD的患者之间WD存在显著差异（p<0.05）。WD与MPDD之间存在显著正相关（r=0.66，p<0.05）。WD与复发性急性胰腺炎显著相关（p<0.05）。