磁共振胰胆管造影与内镜逆行胰胆管造影术诊断胰胆系统疾病的价值

目的以内镜逆行胰胆管造影术(ERCP)为金标准,明确单独使用磁共振胰胆管造影(MRCP)及MRCP+腹部磁共振(MRI)诊断胰胆系统疾病的效果。方法采集1997年1月至2004年11月疑有胰胆系统疾病的病例共186例,对入选患者单独使用MRCP或MRCP+腹部MRI,1 d内再行ERCP,MRCP及ERCP独立进行分析诊断。结果内镜逆行胆管造影术(ERC)的成功率为96.77%,内镜逆行胰管造影术(ERP)的成功率为94.74%,MRCP全部成功。单独使用MRCP及MRCP+腹部MRI诊断胆管结石效果较好。单独使用MRCP对中上段胆管癌诊断的准确性为95.65%,而MRCP+腹部MRI对中上段胆管癌诊断的准确性为97.78%,κ为0.93;单独使用MRCP及MRCP+腹部MRI对壶腹周围癌的诊断效果较中上段胆管癌稍差;单独使用MRCP对胰腺良性疾病诊断效果不佳;MRCP+腹部MRI检查可以提高其对病变诊断的敏感性、特异性及准确性。结论MRCP诊断胆系疾病有较高的敏感性、特异性及准确性,MRCP可部分代替ERCP的诊断功能。

The Comparison between Magnetic Resonance Cholangiopancreatography and Endoscopic Retrograde Cholangiopancreatography in Diagnosis of Pancreatobiliary Diseases

Objective To determine the diagnostic effect of magnetic resonance cholangiopancreatography compared with ERCP in the pancreatobiliary disease.Methods 186 cases suspected pancreatobiliary diseases were collected from Jan,1997 to Nov,2004.MRCP alone or MRCP abdominal MRI should be performed randomly.And then,ERCP within one day.When taking ERCP as the gold standard,it was calculated interms of the sensitivities,specificities,accuracies,positive predictive values,negative predictive values,positive likelilood ratios and negative likelihood ratios.Results Among the 186 cases,the successful cannulation of ERC and ERP was 96.77% and 94.74% respectively.While MRCPs were all successful.The accuracy for MRCP alone and MRCP abdominal MRI in choledocholithiasis was content.The accuracy in the upper and middle part of bile duct of MRCP alone was 95.65%.The statistic value including accuracy and k value of MRCP abdominal MRI had been improved to 97.78% and 0.93 respectively.But it's discontented in diagnosing periampulla carcinoma and the begin diseases of pancreas by MRCP alone and MRCP abdominal MRI.Conclusion MRCP alone has been rather sensitive,specific and accurate in diagnosing biliary diseases.MRCP can replace diagnostic performance of ERCP partially.