Yamaguchi K, Chijiwa K, Shimizu S, Yokohata K, Morisaki T, Tanaka M
Department of Surgery I, Kyushu University Faculty of Medicine, Fukuoka, Japan.
Am J Surg. 1998 Mar;175(3):203-8. doi: 10.1016/s0002-9610(97)00287-0.
Magnetic resonance cholangiopancreatography (MRCP) is a newly developing noninvasive examination of the biliopancreatic trees. Roles of MRCP in the diagnosis of pancreatic diseases have not been scrutinized.
Endoscopic retrograde cholangiopancreatography (ERCP) and MRCP were reviewed in 52 Japanese patients with various pancreatic diseases and 6 patients with normal pancreas to compare their diagnostic usefulness and limitation.
In those with normal pancreas, only the main pancreatic duct was visualized by MRCP, while both the main pancreatic and branch ducts were clearly delineated by ERCP. In 3 patients with serous cystadenoma, the tumor was not visualized by ERCP, whereas it was visible as a high-intensity mass on MRCP. Of 18 patients with a "mucin hypersecreting" tumor of the branch type, MRCP demonstrated cystically dilated branch ducts in all, while ERCP failed to visualize the dilated ducts in 6 patients. However, the details of the cystic lesions (mural nodule, communication with the main pancreatic duct) were more exactly demonstrated by ERCP than MRCP. In 5 patients with a mucin hypersecreting tumor of the main pancreatic duct type, the dilated main pancreatic duct and the presence of mural nodules were similarly demonstrated both by ERCP and MRCP. In 12 patients with pancreatic adenocarcinoma, indirect findings were similarly demonstrated both by ERCP and MRCP, ie, stenosis (4 patients) and obstruction (8) together with dilation of the main pancreatic duct (9). In 3 patients, the center of the mass showed high intensity on MRCP, suggesting the secondary change of pancreatic carcinoma. In 8 patients with obstruction of the main pancreatic duct due to carcinoma, the distal pancreatic duct was visualized by MRCP but not by ERCP. In 9 patients who had undergone pylorus-preserving or standard pancreatoduodenectomy, follow-up MRCP was obtainable in all examined and displayed the main pancreatic duct.
MRCP plays a complementary role in the surgical diagnosis of pancreatic disorders and is especially useful to examine the pancreatic duct after pancreatoduodenectomy.
磁共振胰胆管造影（MRCP）是一种新兴的对胆胰管系统的无创检查。MRCP在胰腺疾病诊断中的作用尚未得到详细研究。
对52例患有各种胰腺疾病的日本患者及6例胰腺正常的患者进行了内镜逆行胰胆管造影（ERCP）和MRCP检查，以比较它们的诊断效用和局限性。
在胰腺正常的患者中，MRCP仅能显示主胰管，而ERCP能清晰显示主胰管和分支胰管。在3例浆液性囊腺瘤患者中，ERCP未能显示肿瘤，而MRCP上肿瘤表现为高信号肿块。在18例分支型“黏液高分泌”肿瘤患者中，MRCP显示所有患者的分支胰管均呈囊性扩张，而ERCP未能显示6例患者的扩张胰管。然而，ERCP比MRCP更能准确显示囊性病变的细节（壁结节、与主胰管的连通情况）。在5例主胰管型黏液高分泌肿瘤患者中，ERCP和MRCP均同样显示了扩张的主胰管和壁结节的存在。在12例胰腺癌患者中，ERCP和MRCP均同样显示了间接征象，即狭窄（4例）和梗阻（8例）以及主胰管扩张（9例）。在3例患者中，肿块中心在MRCP上呈高信号，提示胰腺癌的继发性改变。在8例因癌导致主胰管梗阻的患者中，MRCP能显示远端胰管，而ERCP不能。在9例接受保留幽门或标准胰十二指肠切除术的患者中，所有受检者均可行随访MRCP检查并显示主胰管。
MRCP在胰腺疾病的外科诊断中起补充作用，尤其在胰十二指肠切除术后检查胰管方面很有用。
