胆总管结石的诊断：超声内镜检查还是磁共振胰胆管造影？一项前瞻性对照研究。

Diagnosis of choledocholithiasis: EUS or magnetic resonance cholangiography? A prospective controlled study.

作者信息

de Lédinghen V, Lecesne R, Raymond J M, Gense V, Amouretti M, Drouillard J, Couzigou P, Silvain C

机构信息

Departments of Hepatogastroenterology and Medical Imaging, Hôpital du Haut-Lévêque, Pessac, France.

出版信息

Gastrointest Endosc. 1999 Jan;49(1):26-31. doi: 10.1016/s0016-5107(99)70441-4.

DOI:10.1016/s0016-5107(99)70441-4

PMID:9869719

Abstract

BACKGROUND

Endoscopic ultrasonography (EUS) appears to be the best imaging method for the diagnosis of choledocholithiasis. The aim of this preliminary, prospective, controlled study was to assess the accuracy of EUS and magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of common bile duct stones.

METHODS

From December 1995 through April 1997, all patients referred because of suspicion of the presence of common bile duct stones were included in the study. EUS and MRCP were performed. Each examination was performed by a different operator unaware of the result of the other procedure. The definitive diagnosis was established by means of endoscopic retrograde cholangiography with sphincterotomy or a surgical procedure.

RESULTS

Forty-three patients (18 men, 25 women) with a mean age of 60.9 +/- 14.5 years (range 25 to 81 years) were included in the study. Eleven patients were excluded because of unavailability of magnetic resonance imaging(n = 5) or EUS (n = 6). Ten patients (31.2%) had choledocholithiasis. For this diagnosis, the sensitivity of EUS was 100%, the specificity was 95.4%, the positive predictive value was 90.9%, and the negative predictive value was 100%. The corresponding values for MRCP were 100%, 72.7%, 62.5%, and 100%, not significantly different from EUS results. The accuracy of EUS was 96.9%, and that of MRCP was 82.2%.

CONCLUSION

This preliminary study confirmed EUS as an accurate and noninvasive procedure for the diagnosis of common bile duct stones. MRCP, which had a high sensitivity and high negative predictive value, might be an accurate technique for patients with a contraindication to EUS.

摘要

背景

内镜超声检查（EUS）似乎是诊断胆总管结石的最佳成像方法。这项初步、前瞻性、对照研究的目的是评估EUS和磁共振胰胆管造影（MRCP）在诊断胆总管结石方面的准确性。

方法

从1995年12月至1997年4月，所有因怀疑存在胆总管结石而转诊的患者均纳入本研究。进行了EUS和MRCP检查。每项检查由一名不知道另一项检查结果的不同操作人员进行。通过内镜逆行胆管造影加括约肌切开术或外科手术确定最终诊断。

结果

本研究纳入了43例患者（18例男性，25例女性），平均年龄60.9±14.5岁（范围25至81岁）。11例患者因无法进行磁共振成像（n = 5）或EUS（n = 6）而被排除。10例患者（31.2%）患有胆总管结石。对于该诊断，EUS的敏感性为100%，特异性为95.4%，阳性预测值为90.9%，阴性预测值为100%。MRCP的相应值为100%、72.7%、62.5%和100%，与EUS结果无显著差异。EUS的准确性为96.9%，MRCP的准确性为82.2%。