一项初步可行性研究，旨在确定直接接入式定量磁共振胰胆管造影（MRCP）在评估疑似急性胆系或胆管结石表现中的效用。
Pilot feasibility study to determine the utility of direct access and quantitative magnetic resonance cholangiopancreatography (MRCP) in the assessment of suspected acute biliary or ductal gallstone presentations.
作者信息
Novak Alex, Acharya Anita, Beer Sally, Espinosa Alexis, Smith Giles Bond, Saga Cyrene, Andrews Jane, Bailey Adam, Soonawalla Zahir, Bungay Helen, Pavlides Michael
机构信息
Emergency Medicine Research Oxford (EMROx), Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Emergency Department, John Radcliffe Hospital, HeadleyWay, Headington, Oxford, OX39DU, UK.
出版信息
BMC Gastroenterol. 2025 Feb 10;25(1):72. doi: 10.1186/s12876-025-03637-0.
BACKGROUND
Patients with suspected acute gallstone disease typically undergo abdominal ultrasound. MRCP is often used for patients with abnormal LFTs, potentially making ultrasound unnecessary for this group. Despite high inter-reader variability in MRCP interpretation, new AI technologies may automate and standardize detection and measurement.
METHOD
Patients with suspected acute gallstone disease and abnormal liver function tests were randomized into two diagnostic pathways, direct MRCP and standard care. Admission data, healthcare resource use, and clinical outcomes were recorded. National Health Service national 20/21 tariffs were used to calculate and compare healthcare costs. MRCP scans were subsequently analysed using MRCP + software (Perspectum Ltd).
RESULTS
27 participants were enrolled over 12 months, 15 to direct MRCP and 11 to standard care. One patient was excluded from analysis. Mean patient time to diagnostic report and mean per patient associated direct medical cost and mean cost to diagnosis for the direct MRCP and standard of care group was 2.53 days, £449.54, and £647 respectively for the direct MRCP group and 4.18 days costing £742.06 and £896 for standard care. MRCP + analysis of 11 scans showed significant differences between the groups in terms of gallbladder volume (80.2mm gallstone present versus 30.1mm without, p = 0.018 and cystic duct median width (4.6 mm gallstone present versus 2.7 mm without, p = 0.042).
CONCLUSIONS
Direct MRCP may be a feasible and potentially cost-effective diagnostic strategy for patients with suspected acute gallstone disease and deranged LFTs. Automated measurement of MRCP parameters shows promise in detecting obstruction. Larger trials are warranted to assess this potential.
CLINICAL TRIAL NUMBER
This study is registered with ClinicalTrials.gov (NCT03709030). Registration date: October 17, 2018.
背景
疑似急性胆结石疾病的患者通常会接受腹部超声检查。磁共振胰胆管造影（MRCP）常用于肝功能检查异常的患者，这可能使该组患者无需进行超声检查。尽管MRCP解读的阅片者间差异很大，但新的人工智能技术可能会使检测和测量自动化并标准化。
方法
将疑似急性胆结石疾病且肝功能检查异常的患者随机分为两条诊断途径，即直接进行MRCP检查和标准治疗。记录入院数据、医疗资源使用情况和临床结果。使用英国国家医疗服务体系（NHS）20/21年度收费标准来计算和比较医疗费用。随后使用MRCP +软件（Perspectum有限公司）对MRCP扫描结果进行分析。
结果
在12个月内招募了27名参与者，15名接受直接MRCP检查，11名接受标准治疗。一名患者被排除在分析之外。直接MRCP检查组和标准治疗组的患者平均获得诊断报告的时间、每位患者的平均相关直接医疗费用以及诊断的平均费用分别为：直接MRCP检查组为2.53天、449.54英镑和647英镑，标准治疗组为4.18天、费用为742.06英镑和896英镑。对11次扫描的MRCP +分析显示，两组在胆囊体积（存在胆结石时为80.2mm，无胆结石时为30.1mm，p = 0.018）和胆囊管中位宽度（存在胆结石时为4.6mm，无胆结石时为2.7mm，p = 0.04）方面存在显著差异。
结论
对于疑似急性胆结石疾病且肝功能紊乱的患者，直接进行MRCP检查可能是一种可行且可能具有成本效益的诊断策略。MRCP参数的自动测量在检测梗阻方面显示出前景。有必要进行更大规模的试验来评估这种潜力。
临床试验编号
本研究已在ClinicalTrials.gov（NCT03709030）注册。注册日期：2018年10月17日。
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