Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511, Japan.
Department of Radiology, Kindai University Faculty of Medicine, Osaka, Japan.
Dig Dis Sci. 2024 Aug;69(8):3008-3014. doi: 10.1007/s10620-024-08505-7. Epub 2024 Jun 12.
Detection of a common channel outside the duodenal wall is important in diagnosing pancreaticobiliary maljunction (PBM). The present study evaluated the utility of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) in diagnosing PBM.
This single-center retrospective study enrolled 45 patients who were diagnosed with PBM or high confluence of pancreatobiliary ducts (HCPBD) between January 2007 and December 2021. The diagnostic sensitivities of contrast-enhanced computed tomography (CE-CT), magnetic resonance imaging (MRI), and CH-EUS for diagnosing PBM were analyzed. Imaging findings were evaluated by two reviewers blinded to the clinicopathological results.
Based on diagnostic criteria, 33 patients were diagnosed with PBM and 12 with HCPBD. Compared with the patients with HCPBD, those with PBM had significantly longer common channel (12.5 mm vs. 8.1 mm, P = 0.018) and common bile duct (13.0 mm vs. 8.6 mm, P = 0.049) lengths. The κ-coefficients for differentiating PBM and HCPBD were 0.871 between CE-CT and MRI, 0.330 between CE-CT and CH-EUS, and 0.611 between MRI and CH-EUS. The diagnostic sensitivity of CH-EUS (95.2%) was higher than that of CE-CT (83.3%) and MRI (82.8%), although the differences were not statistically significant.
CH-EUS may be useful for the diagnosis of PBM.
在诊断胰胆管合流异常（PBM）时，检测十二指肠壁外共同通道很重要。本研究评估了对比增强谐波内镜超声（CH-EUS）在诊断 PBM 中的应用价值。
本单中心回顾性研究纳入了 2007 年 1 月至 2021 年 12 月期间被诊断为 PBM 或胰胆管汇合较高（HCPBD）的 45 例患者。分析了增强 CT（CE-CT）、磁共振成像（MRI）和 CH-EUS 诊断 PBM 的诊断灵敏度。两位审阅者对影像学表现进行评估，对临床病理结果不知情。
根据诊断标准，33 例患者被诊断为 PBM，12 例患者被诊断为 HCPBD。与 HCPBD 患者相比，PBM 患者的共同通道（12.5mm 比 8.1mm，P=0.018）和胆总管（13.0mm 比 8.6mm，P=0.049）长度明显更长。CE-CT 和 MRI 鉴别 PBM 和 HCPBD 的κ系数为 0.871，CE-CT 和 CH-EUS 为 0.330，MRI 和 CH-EUS 为 0.611。CH-EUS 的诊断灵敏度（95.2%）高于 CE-CT（83.3%）和 MRI（82.8%），尽管差异无统计学意义。
CH-EUS 可能有助于诊断 PBM。
