Lomanto D, Pavone P, Laghi A, Panebianco V, Mazzocchi P, Fiocca F, Lezoche E, Passariello R, Speranza V
Istituto di Clinica Chirurgica II, University of La Sapienza, Rome, Italy.
Am J Surg. 1997 Jul;174(1):33-8. doi: 10.1016/S0002-9610(97)00022-6.
Magnetic resonance cholangiopancreatography (MRCP) is a new, noninvasive imaging technique for the visualization of the biliary ducts with cholangiographic images similar to those obtained with endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography. No contrast medium injection is used. The aim of this study was to assess the feasibility of MRCP versus ERCP in the diagnosis of biliary tract and pancreatic diseases.
One hundred and thirty-six patients were submitted to MRCP. They were referred to MR study according to four inclusion criteria: (1) evidence or suspicion of choledocholithiasis, (2) benign or malignant bile ducts stenosis, (3) follow-up of patients submitted to biliary-enteric anastomosis, and (4) chronic pancreatitis with Wirsung duct dilatation. The MRCP was performed with a 0.5T superconducting magnet (Philips Gyroscan T5). When neoplastic disease was detected, additional images on axial planes were acquired. MRCP allowed images of diagnostic value to be obtained in all the cases.
In choledocholithiasis, MRCP showed 91.6% sensitivity, 100% specificity, and overall diagnostic accuracy 96.8%. Of 48 patients with stenotic lesions, 16 were correctly characterized as benign and 30 as malignant. Two cases of focal chronic pancreatitis were misdiagnosed as pancreatic head carcinoma. In the patients submitted to biliary-enteric anastomosis, MCRP was able to detect the dilatation of the intrahepatic ducts, the stenosis, and associated stones in all 8 positive cases. In the remaining 7 patients with mild signs of cholangitis, MCRP showed irregular aspects of the biliary tree in the main ducts. In the 11 patients with chronic pancreatitis, MCRP was able to depict the dilated Wirsung duct and the stenotic tract, although the fine details of the secondary ducts were not evaluated due to the low spatial resolution as compared with conventional films.
MRCP can be considered a technique able to completely replace diagnostic ERCP. Further studies are necessary for a better evaluation of the potential advantages and disadvantages of this technique.
磁共振胆胰管造影（MRCP）是一种新的无创成像技术，可用于显示胆管，其胆管造影图像类似于经内镜逆行胰胆管造影和经皮经肝胆管造影所获得的图像。无需注射造影剂。本研究的目的是评估MRCP与ERCP在诊断胆道和胰腺疾病方面的可行性。
136例患者接受了MRCP检查。根据以下四项纳入标准将他们转诊进行磁共振检查：（1）胆总管结石的证据或怀疑；（2）良性或恶性胆管狭窄；（3）接受胆肠吻合术患者的随访；（4）伴有胰管扩张的慢性胰腺炎。使用0.5T超导磁体（飞利浦Gyroscan T5）进行MRCP检查。当检测到肿瘤性疾病时，采集轴位平面的额外图像。MRCP在所有病例中均获得了具有诊断价值的图像。
在胆总管结石方面，MRCP的敏感性为91.6%，特异性为100%，总体诊断准确率为96.8%。在48例有狭窄病变的患者中，16例被正确诊断为良性，30例为恶性。2例局灶性慢性胰腺炎被误诊为胰头癌。在接受胆肠吻合术的患者中，MCRP能够在所有8例阳性病例中检测到肝内胆管扩张、狭窄及相关结石。在其余7例有轻度胆管炎体征的患者中，MCRP显示主胆管中胆管树的不规则形态。在11例慢性胰腺炎患者中，MCRP能够描绘出扩张的胰管和狭窄段，尽管与传统胶片相比，由于空间分辨率较低，二级胰管的细微细节未被评估。
MRCP可被视为一种能够完全替代诊断性ERCP的技术。为了更好地评估该技术的潜在优缺点，还需要进一步的研究。
