磁共振胰胆管成像在梗阻性黄疸评估中的作用。
Role of Magnetic Resonance Cholangiopancreatography in the Evaluation of Obstructive Jaundice.
机构信息
Department of Radiodiagnosis and Imaging, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal.
出版信息
Kathmandu Univ Med J (KUMJ). 2021;19(73):35-40.
Background Magnetic Resonance Cholangiopancreatography is a reliable and highly sensitive imaging modality in the diagnosis of Obstructive jaundice. Objective To evaluate the diagnostic accuracy of Magnetic Resonance Cholangiopancreatography as compared to Endoscopic Retrograde Cholangiopancreatography. Method A prospective, analytical study was conducted in the Department of Radiodiagnosis and Imaging at Dhulikhel Hospital between October 2018 and December 2020. Altogether 100 patients of all ages with obstructive jaundice undergoing Magnetic Resonance Cholangiopancreatography and Endoscopic Retrograde Cholangiopancreatography were included. The causes of obstructive jaundice as identified by Magnetic Resonance Cholangiopancreatography were compared to that of Endoscopic Retrograde Cholangiopancreatography considering Endoscopic Retrograde Cholangiopancreatography as gold standard for the diagnosis. Result Magnetic Resonance Cholangiopancreatography revealed choledocholithiasis in 60 (60%) patients, benign stricture - 14(14%), malignant stricture-11(11%), periampullary carcinoma in 8(8%) and normal study in 4(4%) patients. Endoscopic Retrograde Cholangiopancreatography showed choledocholithiasis in 59(59%) patients, strictures (benign in 13%, malignant in 10%), ascariasis in 3(3%) and normal findings in 5(5%) patients. The sensitivity, specificity, positive predictive value and negative predictive value of Magnetic Resonance Cholangiopancreatography in detecting choledocholithiasis were 96.6%, 92.3%, 95%, and 95%. The same values for benign strictures were 92.3%, 97.7%, 85.7% and 98.9%, whereas those for malignant strictures were 90.9%, 98.8%, 90.9% and 98.8%. All values were 100% for peri-ampullary carcinoma and ascariasis. Hence, Magnetic Resonance Cholangiopancreatography showed good accuracy for detecting causes of obstructive jaundice (p < 0.05) as compared to Endoscopic Retrograde Cholangiopancreatography. Conclusion Magnetic Resonance Cholangiopancreatography is an accurate, non-invasive technique in evaluation of obstructive jaundice and offers similar diagnostic value compared to Endoscopic Retrograde Cholangiopancreatography.
背景磁共振胰胆管成像（Magnetic Resonance Cholangiopancreatography，简称 MRCP）是诊断梗阻性黄疸的可靠且高度敏感的影像学方法。目的 与内镜逆行胰胆管造影术（Endoscopic Retrograde Cholangiopancreatography，简称 ERCP）相比，评估磁共振胰胆管成像术（Magnetic Resonance Cholangiopancreatography，简称 MRCP）的诊断准确性。方法 这是一项在 2018 年 10 月至 2020 年 12 月期间在 Dhulikhel 医院放射诊断和影像科进行的前瞻性分析性研究。共纳入 100 例年龄在任何年龄段的梗阻性黄疸患者，这些患者均接受了磁共振胰胆管成像术（Magnetic Resonance Cholangiopancreatography，简称 MRCP）和内镜逆行胰胆管造影术（Endoscopic Retrograde Cholangiopancreatography，简称 ERCP）检查。以 ERCP 为诊断金标准，比较磁共振胰胆管成像术（Magnetic Resonance Cholangiopancreatography，简称 MRCP）诊断出的梗阻性黄疸的病因与 ERCP 诊断出的病因。结果磁共振胰胆管成像术（Magnetic Resonance Cholangiopancreatography，简称 MRCP）显示胆总管结石 60 例（60%），良性狭窄 14 例（14%），恶性狭窄 11 例（11%），壶腹周围癌 8 例（8%），正常 4 例（4%）。内镜逆行胰胆管造影术（Endoscopic Retrograde Cholangiopancreatography，简称 ERCP）显示胆总管结石 59 例（59%），狭窄（良性 13%，恶性 10%），蛔虫病 3 例（3%），正常 5 例（5%）。磁共振胰胆管成像术（Magnetic Resonance Cholangiopancreatography，简称 MRCP）检测胆总管结石的灵敏度、特异度、阳性预测值和阴性预测值分别为 96.6%、92.3%、95%和 95%。良性狭窄的相同值分别为 92.3%、97.7%、85.7%和 98.9%，而恶性狭窄的相同值分别为 90.9%、98.8%、90.9%和 98.8%。壶腹周围癌和蛔虫病的所有值均为 100%。因此，与内镜逆行胰胆管造影术（Endoscopic Retrograde Cholangiopancreatography，简称 ERCP）相比，磁共振胰胆管成像术（Magnetic Resonance Cholangiopancreatography，简称 MRCP）在检测梗阻性黄疸的病因方面具有较好的准确性（p < 0.05）。结论磁共振胰胆管成像术（Magnetic Resonance Cholangiopancreatography，简称 MRCP）是一种准确、非侵入性的技术，可用于评估梗阻性黄疸，并提供与内镜逆行胰胆管造影术（Endoscopic Retrograde Cholangiopancreatography，简称 ERCP）相似的诊断价值。
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