磁共振胰胆管造影术与直接造影术比较对胰胆系疾病的诊断价值

磁共振胰胆管造影术与直接造影术比较对胰胆系疾病的诊断价值张澍田于中麟马大庆磁共振胰胆管造影术（ＭＲＣＰ）是近年来用于诊断胰胆系疾病的新技术，现介绍其发展概况、适应证、诊断价值，并将其与诊断胰胆系疾病的“金标准”——内镜下逆行性胰胆管造影术（ＥＲＣＰ）...     

磁共振胰胆管造影术与内镜逆行胰胆管造影术的对照研究

目的 通过磁共振胰胆管造影术（ＭＲＣＰ）与内镜逆行胰胆管造影术（ＥＲＣＰ）的对照研究,评价ＭＲＣＰ对胰胆系疾病的诊断价值。方法 ４０例疑有胰胆系疾病的患者进行了ＭＲＣＰ及ＥＲＣＰ检查,两者结果作对照研究。结果 本组资料中ＭＲＣＰ对胰胆系疾病总的诊断价值为敏感度８９．１％、特异度１００％、准确度９０％,ＥＲＣＰ总的诊断价值为敏感度８４．２％、特异度１００％、准确度８５％,两者统计学上无显著性差异。结     

胆胰疾病磁共振误诊及与ERCP结果比较分析

磁共振胰胆管显影术（MRCP）作为一种无创性诊断技术，其临床应用日趋增多，而经内镜逆行胰胆管造影（ERCP）作为胆胰系疾病的诊断金标准已在临床应用多年。为了评价MRCP和ERCP对胆胰系疾病的诊断价值，我们分析了56例胆胰疾病病例磁共振胰胆管造影（MRCP）误诊情况及与ERCP结果进行比较，报道如下。     

治疗性经内镜逆行性胰胆管造影术在老年胆胰疾病患者治疗中的应用价值

目的探讨经内镜逆行性胰胆管造影术(ERCP)在老年胆胰疾病诊疗中的应用价值。方法选取行ERCP治疗的患者230例分为老年组及非老年组,两组患者均接受ERCP治疗,对比两组患者胆胰疾病的组成情况、ERCP的操作方式、ERCP的治疗成功率和并发症的发生情况。结果老年组胆源性胰腺炎的发生率显著低于非老年组,而胆管癌的发生率显著高于非老年组(均P<0.05);老年组行经内镜胆道内支架放置术显著多于非老年组(P<0.05);两组患者ERCP成功率及并发症发生率无差异(P>0.05)。结论治疗性ERCP具有成功率高、临床疗效稳定、安全性好,并发症少等优势,是老年胆胰疾病较为理想的治疗方法。     

胆胰疾病行治疗性内镜逆行性胰胆管造影术811例临床分析

目的探讨治疗性内镜逆行性胰胆管造影术(ERCP)在胆胰疾病中的应用价值及其并发症的防治。方法回顾性分析上海中医药大学附属普陀医院2001年9月至2006年9月行治疗性ERCP的811例胆胰疾病患者的临床资料。结果562例胆总管结石患者中行乳头切开术(EST)474例,行乳头气囊扩张术(EPBD)88例,结石总清除率为95%;244例恶性胆道梗阻患者中183例行鼻胆管引流(ENBD),61例行胆道内支架引流术(ERBD);5例恶性胆胰管梗阻患者行胆胰管双支架引流术。行胆道内支架引流可使血清胆红素明显下降,胰管支架置入可使上腹部疼痛有一定程度减轻。并发症:乳头切开处出血13例(1.6%),均发生于EST术后;急性胰腺炎43例(5.3%),其中发生于EST术后32例,EPBD术后7例,ENBD术后2例,ERBD术后2例;EST术后发生急性胆囊炎4例(0.5%);全组死亡2例(0.2%)。结论应用十二指肠镜行治疗性ERCP去除胆管结石,控制胆道炎症,解除胆胰管恶性梗阻是一种理想的微创外科方法,熟练的技术与细致的围手术期处理是防治并发症关键。     

经内镜逆行胰胆管造影诊治胆胰疾病1147例分析

内镜下逆行胰胆管造影术(ERCP)是胰胆管疾病重要的诊断和治疗方法。随着该技术的不断发展,临床应用范围逐渐扩大,单纯诊断性ERCP逐渐被治疗性ERCP所取代[1,2]。本文对6年来我们研究所1147例ERCP进行了分析。 一、资料和方法 1.一般资料:自1996年1月至2002年1月,我所采用内镜进行ERCP诊治1147例患者,男591例,女556例,年     

经内镜逆行胰胆管造影诊治胆胰疾病的护理体会

内镜下逆行性胰胆管造影术(endoscopic retrograde cholangiopancreatograply，ERCP)是胰胆管疾病重要的诊断和治疗方法，我院自1999年10月至2003年6月行诊断性和治疗性ERCP共326例次，同时实施针对性的护理，取得满意效果。     

经内镜逆行胰胆管造影术在治疗合并消化道狭窄的胆胰疾病患者中的应用价值

背景 随着目前医学诊疗技术的飞速发展,手术微创化,已成为疾病诊疗新趋势,而经过数十年的发展,经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)已成为微创治疗胆胰疾病的首选手段之一,但是,当胆胰疾病合并消化道狭窄时,行ERCP难度往往较大,目前...     

磁共振胰胆管造影术对胰胆系疾病的诊断价值

目的通过磁共振胰胆管造影术(MRCP)与经内镜逆行胰胆管造影术(ERCP)的对照研究,评价MRCP对胰胆系疾病的诊断价值.方法40例疑有胰胆系疾病的患者在PhilipsGyroscanNT1.0T超导系统上作MRCP检查,ERCP采用常规方法检查.患者男24例,女16例,年龄34岁～68岁,平均56岁.28例先行MRCP后再作ERCP,12例先行ERCP,大部分患者两者间隔时间1d～2d,最长达7d.两者结果作对照研究.结果本组资料中,MRCP对胰胆系疾病总的诊断价值为敏感度89.1%、特异度100%、准确度90%,ERCP总的诊断价值为敏感度84.2%、特异度100%、准确度85%,两者统计学上无显著性差异(x2=0.11,P>0.05).结论MRCP具有无创伤性,与ERPC相比较,在诊断胰胆系疾病方面具有同等的价值,但没有治疗作用,目前尚难以取代ERCP.     

磁共振胰胆管成像和直接胰胆管造影对胆胰疾病诊断价值自身对比的前瞻性研究

目的 比较直接胰胆管造影（ERCP和PTC）和磁共振胰胆管成像（MRCP）对胆胰疾病的诊断价值。方法 临床怀疑胆胰系疾病63例。每例先行MRCP,在此后24h内行ERCP。影像科和内镜医师分别报告自己所见结果,待研究结束后,以ERCP或PTC为参照标准统一对比分析。结果 63例行ERCP中,成功率为88.9%（56/63例）,7例ERCP失败者改行PTC检查成功;所有MRCP均获成功,成功率为100.0%;MRCP的灵敏度为98.2%、特异度83.3%、误诊率为16.7%、漏诊率为1.8%。MRCP和ERCP（或PTC）总符合率85.7%,其中在胆系结石及胆管肿瘤分别为100.0%和92.9%,乳头病病变为70.6%（12/17例）,在慢性胰腺炎和肝吸虫的诊断符合率分别为3/3和66.7%。63例ERCP者,术后并发胰腺炎5例、肾周脓肿1例（为B-Ⅱ术后）,并发症发生率为9.5%（6/63例）;而MRCP无并发症发生。结论 对胆管内疾病,MRCP可达到ERCP的单纯诊断水平,而对乳头部病变（尤其是小病变）和肝吸虫,MRCP却无法与ERCP相比拟。对不能耐受ERCP及禁忌症者,MRCP是较好的选择。MRCP的最大不便在于不能同时进行治疗。     

ERCP和MRCP及PTC在胆胰疾病诊断与治疗中的应用

ERCP、MRCP、PTC作为影像学手段在胆胰疾病的诊断与治疗中起极为重要的作用。3者在临床应用中各有优缺点,应合理加以选择。     

磁共振胰胆管造影、超声内镜与逆行胰胆管造影诊断阻塞性黄疸的价值

目的：比较磁共振胰胆管造影（MRCP）、超声内镜（EUS）与内镜逆行胰胆管造影（ERCP）诊断阻塞性黄疸的价值。方法：39例阻塞性黄疸患者分别行MRCP、EUS和ERCP。MRCP采用重T2加权及超快速自旋回波水成像技术进行,EUS和ERCP按常规进行。结果：MRCP、EUS与ERCP诊断准确率分别为87．2％（34／39例）、94．9％（37／39例）和97．4％（38／39例）;对恶性狭窄的诊断准确率分别为61．5％（8／13例）、84．6％（11／13例）和92．3％（12／13例）;对胆总管结石的诊断准确率均为100．0％（21／21例）。结论：MRCP为无创性检查,在明确阻塞性黄疸病因时可作为首选方法,目前尚不能取代ERCP。EUS作为诊断胆、胰系统疾病的重要方法,与MRCP和ERCP结合,能提高阻塞性黄疸诊断 的准确率。     

MRCP and MRI findings in 9 patients with autoimmune pancreatitis

AIM: To evaluate magnetic resonance cholangiopancre-atography (MRCP) findings in conjunction with magnetic resonance (MR) images in autoimmune pancreatitis (AIP) patients. METHODS: Nine patients with AIP underwent MRI, MRCP, endoscopic retrograde cholangiopancreatography (ERCP), computed tomography, and ultrasonography. The MRCP and MR images taken before and after steroid therapy were reviewed and compared with other imaging modalities. The MRCP findings of the AIP cases were compared to those of 10 cases with carcinoma of the head of the pancreas. RESULTS: On MRCP, the narrowed portion of the main pancreatic duct noted on ERCP was not visualized, while the non-involved segments of the main pancreatic duct were visualized. The degree of upstream dilatation of the proximal main pancreatic duct was milder than that seen in cases of pancreatic carcinoma. Stenosis or obstruction of the lower bile duct was detected in 8 patients. MR images showed enlargement of the pancreas with decreased signal intensity on T1-weighted MR images, increased signal intensity on T2-weighted MR images, and, in 3 patients, a hypointense capsule-like rim. After steroid therapy, the previously not visualized portion of the main pancreatic duct was seen, along with improvement of the bile duct stenosis. Pancreatic enlargement decreased, and the abnormal signal intensity on both T1- and T2-weighted MR images became isointense. CONCLUSION: MRCP cannot differentiate irregular narrowing of the main pancreatic duct seen with AIP from stenosis of the main pancreatic duct seen with pancreatic carcinoma. However, MRCP findings in conjunction with MR imaging of pancreatic enlargement that shows abnormal signal intensity on T1- and T2-weighted MR images are useful in supporting a diagnosis of AIP.     

Pancreatitis in patients with pancreas divisum:Imaging features at MRI and MRCP

AIM:To determine the magnetic resonance cholangiopancreatography(MRCP)and magnetic resonance imaging(MRI)features of pancreatitis with pancreas divisum(PD)and the differences vs pancreatitis without divisum.METHODS:Institutional review board approval was obtained and the informed consent requirement was waived for this HIPAA-compliant study.During one year period,1439 consecutive patients underwent successful MRCP without injection of secretin and abdominal MRI studies for a variety of clinical indications using a 1.5 T magnetic resonance scanner.Two experienced radiologists retrospectively reviewed all the studies in consensus.Disputes were resolved via consultation with a third experienced radiologist.The assessment included presence and the imaging findings of PD,pancreatitis,and distribution of abnormalities.The pancreatitis with divisum constituted the study group while the pancreatitis without divisum served as the control group.MRCP and MRI findings were correlated with final diagnosis.Fisher exact tests and Pearson × 2 tests were performed.RESULTS:Pancreatitis was demonstrated at MRCP and MRI in 173 cases(38 cases with and 135 cases without divisum)among the 1439 consecutive cases.The recurrent acute pancreatitis accounted for 55.26%(21 of 38)in pancreatitis patients associated with PD,which was higher than 6.67%(9 of 135)in the control group,whereas the chronic pancreatitis was a dominant type in the control group(85.19%,115 of 135)when compared to the study group(42.11%,16 of 38)(χ 2 = 40.494,P < 0.0001).In cases of pancreatitis with PD,the dorsal pancreatitis accounted for a much higher percentage than that in pancreatitis without PD(17 of 38,44.74% vs 30 of 135,22.22%)(χ 2 = 7.257,P < 0.05).CONCLUSION:MRCP and MRI can depict the features of pancreatitis associated with divisum.Recurrent acute pancreatitis and isolated dorsal involvement are more common in patients with divisum.     

MRCP vs. ERCP in the evaluation of biliary pathologies: review of current literature

OBJECTIVE: Recently developed magnetic resonance (MR) techniques permit fast and correct imaging of the entire biliary tree with a high spatial resolution. The aim of this study was to compare the diagnostic potential of one of these new MR sequences in magnetic resonance cholangiopancreatography (MRCP) procedure and endoscopic retrograde cholangiopancreatography (ERCP) with review of current literatures. METHODS: A total of 295 patients were enrolled in this study prospectively. Of these, 11 were excluded from the study due to inadequate MRCP image quality and 15 more were excluded due to unsuccessful cannulation during ERCP. Thus, finally 269 patients (124 men and 145 women with a mean age of 57 years; range: 23–92 years) were included. The MRCP procedure was performed before the ERCP in all cases. All MRCP studies were performed with recently developed new MR technique using a heavily T2‐weighted turbo spin echo (TSE) sequence. This TSE sequence is currently one of the most widely used multiplanar 3‐D MR technique, having a high spatial resolution and fast imaging capacity. RESULTS: The study participants were classified into four main groups; normal into group I, stone disease into group II, tumor into group III and others into group IV. Group I consisted of 228 patients who had a normal pancreaticobiliary tree on both the MRCP and ERCP examinations. In group II there were 18 patients, for whom the MRCP had a 88.9% sensitivity and a 100% specificity for diagnosing biliary stone disease. Its positive predictive value (PPV), negative predictive value (NPV) and accuracy rates were 100%, 99.2% and 99.2%, respectively. The MRCP had a 100% sensitivity and a 100% specificity for 20 patients in group III. It also had 100% PPV, 100% NPV, and 100% total accuracy rates in this group. In three patients in group IV, the MRCP had a 100% sensitivity and specificity, respectively. Its PPV, NPV and accuracy were 100%, 100% and 100%, respectively. CONCLUSION: MRCP is used with increasing frequency as a non‐invasive alternative to ERCP and the diagnostic results of MRCP with a heavily T2‐weighted TSE MR sequence and ERCP are comparable with high accuracy in various hepatobiliary pathologies.     

ERCP in acute biliary pancreatitis

The role of urgent endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis is for many years a subject for disagreement among physicians. Although the evidence seemed to be in favor of performing ERCP, endoscopists usually hesitate to conform to the guidelines. ERCP is an invasive procedure, with complications which can affect patients' outcome. Recent evidence suggests that we should probably modify our policy, recruiting less invasive procedures, like magnetic resonance cholangiopancreatography and endoscopic ultrasound, before conducting ERCP in patients with acute biliary pancreatitis. In this editorial the different aspects regarding the role of ERCP in acute biliary pancreatitis are discussed.     

Quantification of pancreatic exocrine function of chronic pancreatitis with secretin-enhanced MRCP

AIM:To obtain reference values for pancreatic flow output rate(PFR)and peak time(PT)in healthy volunteers and chronic pancreatitis(CP);to correlate quantification of secretin enhanced magnetic resonance cholangiopancreatography(SMRCP)of pancreatic fluid output following secretin with fecal elastase-1(FE-1)tests.METHODS:The present study includes 53 subjects comprised of 17 healthy individuals and 36 patients with CP from April 2011 to January 2013.The 36 patients with CP were divided into three groups of mild CP(n=14),moderate CP(n=19)and advanced CP(n=3)by M-ANNHEIM classification for CP..Fifty-three cases underwent FE-1 test and magnetic resonance imaging using 3.0 T-device(Signa EXCITE,GE Healthcare).Coronal T2-weighted single-shot turbo spin-echo,spiratory triggered,covering the papillae,duodenum and small bowel.MRCP was performed with a heavily T2-weighted fat-suppressed long TE HASTE sequence (thick slab 2D MRCP sequence),repeated every 2 min up to 11 min after 0.1 mL/kg secretin injection(Secrelux,Sanochemia,Germany).FE-1 test used sandwich enzyme-linked immunosorbent assay(ELISA)test(ScheBo.Tech,Germany).RESULTS:A good linear correlation showed between the calculated volume and the actual volume by Phantom experiments.Fifty-three paired Quantification of secretin enhanced magnetic resonance cholangiopancreatography(MRCPQ)and FE-1 data sets were analyzed.The mean FE-1 of 53 cases was 525.41±94.44μg/g for 17 healthy volunteers,464.95±136.13μg/g for mild CP,301.55±181.55μg/g for moderate CP,229.30±146.60μg/g for advanced CP.Also,there was statistically significant difference in FE-1(P=0.0001)between health and CP.The mean values of PFR and PT were 8.18±1.11 mL/min,5.76±1.71 min for normal;7.27±2.04 mL/min,7.71±2.55 min for mild CP;4.98±2.57 mL/min,9.10±3.00 min for moderate CP;4.13±1.83 mL/min,12.33±1.55 min for advanced CP.Further,statistically significant difference in PFR(P=0.0001)and PT(P=0.0001)was observed between health and CP.Besides,there was correlation(r=0.79)and consistency(K=0.6     

Correlation Between Findings on MRCP and Gadolinium-Enhanced MR of the Liver and a Survival Model for Primary Sclerosing Cholangitis

Primary sclerosing cholangitis is a chronic, progressive disease of inflammation and fibrosis of the bile ducts. The ability to predict survival is important for appropriate management and treatment decisions. The purpose of this study was to examine the relationship between specific findings on the enhanced magnetic resonance imaging (MRI) examination of the liver and the corresponding magnetic resonance cholangiopancreatogram (MRCP) and a survival model for primary sclerosing cholangitis (PSC), the Mayo Risk Score. During a five-year period, 47 patients with primary sclerosing cholangitis were identified who had a complete MRI/MRCP examination. The extent of anatomical changes of the biliary tree and the degree of peribiliary enhancement in the hepatic parenchyma were compared with the Mayo Risk Score for each patient. Peribiliary enhancement was present to a varying extent in 38 of 47 cases of PSC. Peribiliary enhancement 3 min after gadolinium administration had a weak correlation with the Mayo Risk Score (analysis of variance P < 0.01, Pearson correlation r = 0.37). No statistically significant relationship between the severity of extrahepatic or intrahepatic duct changes and the Mayo Risk Score was found (analysis of variance P = 0.24, P = 0.38, respectively). Although biliary tree changes on MRCP aid in the diagnosis of PSC, they do not correlate with survival, as predicted by the Mayo Risk Score. Peribiliary enhancement on MRI of the liver is a finding occurring to a variable extent in primary sclerosing cholangitis but does not correlate significantly with survival.     

EUS和MRCP对胆总管结石诊断准确性试验的Meta分析

目的通过Cochrane协作网推荐的头对头比较的诊断准确性试验(DTA)的Meta分析方法,系统评价和比较超声内镜(EUS)和磁共振胰胆管成像(MRCP)对胆总管结石的诊断价值。方法检索Ovid Medline、PubMed、EmBase、Cochrane Library、Clinical Trials和ISI Web of Knowledge数据库中建库至2019年1月有关EUS和MRCP对胆总管结石诊断价值的文献。公认的参考标准为经内镜逆行胰胆管造影(ERCP)、术中胆管造影(IOC)或阴性病例临床随访>3个月。使用QUADAS-2工具评价纳入研究的质量。采用RevMan 5.2、STATA 12和Meta-DiSc 1.4软件进行Meta分析,合并诊断效应量,绘制森林图和SROC曲线并计算曲线下面积(AUC),比较EUS和MRCP对胆总管结石的诊断效能。结果共纳入32项研究中的5项,累计病例272例。纳入的研究均未表现出高偏倚风险。随机效应模型合并统计显示,EUS诊断胆总管结石的灵敏度为0.97,特异度为0.90,阳性似然比为7.54,阴性似然比为0.07,诊断比值比(DOR)为162.55。MRCP诊断胆总管结石的灵敏度为0.87,特异度为0.92,阳性似然比为8.99,阴性似然比为0.19,DOR为79.02。EUS的合并DOR明显高于MRCP(P=0.008),进一步分析表明,这主要是由于EUS的灵敏度显著高于MRCP(P=0.006)。两种方式的特异度差异无统计学意义(P=0.42)。SROC曲线显示,EUS和MRCP的AUC分别为0.9771和0.9523,Q*统计量分别为0.9320和0.8936,但差异无统计学意义(P>0.05)。结论EUS和MRCP对胆总管结石均能提供良好的诊断准确性,但EUS具有更高的诊断准确性和灵敏度,且具有相当的特异度。在适当的情况下,EUS应被纳入胆总管结石疑似患者的诊断方式中。