Zidi S H, Prat F, Le Guen O, Rondeau Y, Rocher L, Fritsch J, Choury A D, Pelletier G
Department of Hepatogastroenterology, Bicêtre Hospital, 94 275 Le Kremlin Bicêtre, France.
Gut. 1999 Jan;44(1):118-22. doi: 10.1136/gut.44.1.118.
Magnetic resonance cholangiography (MRC) is a new technique for non-invasive imaging of the biliary tract.
To assess the results of MRC in patients with suspected bile duct stones as compared with those obtained with reference imaging methods.
PATIENTS/METHODS: 70 patients (34 men and 36 women, mean (SD) age 71 (15.5) years; median 75) with suspected bile duct stones were included (cholangitis, 33; pancreatitis, three; suspected post-cholecystectomy choledocholithiasis, nine; cholestasis, six; stones suspected on ultrasound or computed tomography scan, 19). MR cholangiograms with two dimensional turbo spin echo sequences were acquired. Endoscopic retrograde cholangiography with or without sphincterotomy (n = 63), endosonography (n = 5), or intraoperative cholangiography (n = 2) were the reference imaging techniques used for the study and were performed within 12 hours of MRC. Radiologists were blinded to the results of endoscopic retrograde cholangiography and previous investigations.
49 patients (70%) had bile duct stones on reference imaging (common bile duct, 44, six of which impacted in the papilla; intrahepatic, four; cystic duct stump, one). Stone size ranged from 1 to 20 mm (mean 6.1, median 5.5). Twenty seven patients (55%) had bile duct stones smaller than 6 mm. MRC diagnostic accuracy for bile duct lithiasis was: sensitivity, 57.1%; specificity, 100%; positive predictive value, 100%; negative predictive value, 50%.
Stones smaller than 6 mm are still often missed by MRC when standard equipment is used. The general introduction of new technical improvements is needed before this method can be considered reliable for the diagnosis of bile duct stones.
磁共振胆胰管造影（MRC）是一种用于胆道无创成像的新技术。
与参考成像方法相比，评估MRC在疑似胆管结石患者中的检查结果。
患者/方法：纳入70例疑似胆管结石患者（34例男性，36例女性，平均（标准差）年龄71（15.5）岁；中位数75岁）（胆管炎33例；胰腺炎3例；疑似胆囊切除术后胆总管结石9例；胆汁淤积6例；超声或计算机断层扫描怀疑有结石19例）。采用二维快速自旋回波序列进行磁共振胆胰管造影。研究采用的参考成像技术为内镜逆行胰胆管造影（有或无括约肌切开术，n = 63）、内镜超声检查（n = 5）或术中胆管造影（n = 2），且均在MRC检查后12小时内进行。放射科医生对内镜逆行胰胆管造影结果及既往检查情况不知情。
参考成像显示49例患者（70%）有胆管结石（胆总管结石44例，其中6例嵌顿于乳头；肝内结石4例；胆囊管残端结石1例）。结石大小为1至20毫米（平均6.1毫米，中位数5.5毫米）。27例患者（55%）的胆管结石小于6毫米。MRC对胆管结石的诊断准确性为：敏感性57.1%；特异性100%；阳性预测值100%；阴性预测值50%。
使用标准设备时，MRC仍经常漏诊小于6毫米的结石。在该方法被认为可可靠诊断胆管结石之前，需要普遍引入新的技术改进。
