MRCP与ERCP对胆道梗阻性疾病的对比分析

目的:探讨磁共振胰胆管成像(MRCP)及内镜逆行胰胆管造影(ERCP)对胆道梗阻的诊断价值.方法:对30例胆道梗阻患者进行MRCP和ERCP检查,并经手术和病理证实.结果:30例MRCP均获得成功,而ERCP成功率为(29/30)96.7%.MRCP和ERCP总的诊断准确率分别为86.7%和90.0%;其中对恶性病变的诊断准确率分别为87.5%和75.0%;对胆道结石诊断的准确率分别94.4%和100%.结论:MRCP是一种安全有效、非侵袭性、不使用造影剂及无并发症的检查手段,易被患者接受,且其检查成功率高,可作为胆系梗阻性病变的首选检查方法,但不能取代ERCP.     

MRCP与ERCP、PTC诊断胆道梗阻性疾病的对比研究

目的 :探讨磁共振胰胆管成像 (MRCP)加梗阻部位薄层扫描或增强扫描、内镜逆行胰胆管造影 (ERCP)、经皮肝穿刺胆道造影 (PTC)对胆道梗阻的诊断价值。材料和方法 :回顾性分析 42例临床怀疑胆道梗阻患者的MRCP资料 (包括薄层或增强扫描 ) ,并与 18例ERCP、9例PTC比较 ,所有病例均经手术病理证实。结果 :MRCP加梗阻部位薄层扫描或增强扫描对胆管梗阻诊断准确率为 90 .5 % ,ERCP为 88.9% ,PTC为 88.9%。结论 :MRCP加梗阻部位薄层扫描或增强扫描对胆管梗阻具有重要诊断价值。     

磁共振胰胆管成像对恶性胆道梗阻的诊断价值

目的：评价磁共振胰胆管成像（MRCP）对恶性胆道梗阻性疾病的临床诊断价值，探讨肝外恶性胆道梗阻的MRCP、MRI诊断及鉴别诊断。方法：回顾性分析69例恶性胆道梗阻患者的MRI及MRCP表现，并与CT、US、直接胆道造影和手术病理结果对照。MRCP采用二维（2D）和／或三维（3D）屏气半傅立叶转换快速自旋回波（FASE）序列T2加权成像技术。结果：69例MRCP检查均一次成功，全部病例胰胆管显示满意，与直接胆道造影对照，二者所获图像极其相似。MRCP对恶性胆道梗阻定位诊断准确率为98．5％定性诊断准确率为95．6％。结论：MRCP对恶性胆道梗阻定位及定性诊断优于CT和US，是诊断恶性胆道梗阻的一种有效的非侵袭性的检查方法。     

MRCP与CT技术对胆道梗阻性疾病的诊断价值

磁共振胰胆管成像(magnetic resonance cholangiopancreatography,MRCP)是近年广泛应用于临床的一项MR新技术,具有诊断准确性高、无创伤、简便安全、可多方位旋转、多角度观察、不需对比剂等优点,为胰胆管疾病提供了获得类似经皮肝穿胆道造影(PTC)、内镜下逆行胆胰管造影(ERCP)的胰胆管图像,在胆系疾病诊断中得到广泛应用[1,2].本文对2009年10月～2012年2月间85例胆道梗阻性疾病患者分别采用MRCP与多层螺旋CT诊断,探讨两种诊断方法在胆道梗阻性疾病临床诊断中的临床价值.     

HASTE序列磁共振胰胆管成像诊断胆管梗阻性疾病的价值

目的探讨采用半傅立叶单次激发快速自旋回波序列(HASTE)的磁共振胰胆管成像(MRCP)对胆管梗阻性疾病的诊断价值.方法使用1.5T磁共振扫描仪,以HASTE序列对45例可疑胆管梗阻性疾病患者行MRCP检查,原始图像作三维重建,然后分析其影像表现及诊断结果,并与B超、CT和ERCP或PTC进行比较.结果本组45例中MRCP确诊42例,误诊3例,确诊率94%,与ERCP(92%)相近,明显高于CT和B超.恶性梗阻的胆管扩张程度较良性梗阻重,且胆管中断以截断状多见,其次为乳头状和鼠尾状.结合MRCP原始图像和常规MRI能明确显示肿瘤大小及范围.MRCP鉴别良恶性梗阻的敏感性90%,特异性96%,准确性94%.结论HASTE成像速度快,空间分辨高,是目前理想的MRCP成像序列.HASTEMRCP作为无创性技术,完整清晰地显示胰胆管系统结构,提高了梗阻性疾病的定位和定性诊断率,为临床保守或手术治疗提供可靠依据.     

恶性胆道梗阻的MRCP诊断(附21例分析)

目的　评价MRCP对恶性胆道梗阻的诊断价值。方法　 2 1例经临床及CT发现恶性胆道梗阻者行MRCP检查 ,结合MR平扫及手术病理对照。结果　MRCP对恶性胆道梗阻有较高的诊断率 ,6 8%～ 10 0 %。扩张的肝内胆管呈枯枝样或腊肠样 ,低位梗阻的胆总管末端大多呈截断状、杯口状或鼠尾状。结论　MRCP诊断恶性胆道梗阻准确率高 ,可作为不宜行ERCP的替代检查方法。     

MRCP联合MRI在胰胆管梗阻性疾病中诊断的价值

目的:探讨MRCP联合MRI对胰胆管梗阻性疾患定位和定性诊断的价值.方法:对2000年9月～2007年9月842例梗阻性黄疸患者的MRCP及MRI的图像进行分析,并与CT、US、直接胆道造影和临床手术病理结果对照.结果:全部病例MRCP 检查均一次成功,其中320例行直接胆道造影,与MRCP 对照,二者所获图像极其相似.MRCP 对梗阻定位诊断准确率为96.79%,MRCP联合MRI可提高到100%;MRI对梗阻定性诊断准确率为89.19%,联合MRCP可提高至97.74%.CT对梗阻的定位、定性诊断率分别为78.61%,77.59%;US对梗阻的定位、定性诊断率分别为89.73%,82.47%.结论:MRCP联合MRI作为无创性检查技术,对胆胰管梗阻性疾病的定位与定性诊断准确率均高于CT及US;可作为胆系梗阻性病变诊断的首选检查.     

磁共振胰胆管成像诊断胆系梗阻性疾病的临床评价

目的　探讨磁共振胰胆管成像 (MRCP)对胆道梗阻性疾病的临床诊断价值。方法　对 42例胆道梗阻患者进行MRCP检查 ,并经手术病理或 /和其它影像学和临床资料证实。结果　①本组MRCP定位诊断率为 10 0 % ,定性准确率为 83 % ;②扩张的胆道表现为枯枝状 2 3例、软藤状 15例、腊肠样 4例 ;③梗阻端呈倒杯口状 6例、截断状 5例、杵状 17例、鸟嘴状 9例、鼠尾状 5例。结论　MRCP对胆道梗阻性疾病定位诊断准确 ,结合MRI及源像对胆道梗阻性疾病的定性诊断也具有较高的特异性 ,是一种安全快捷、非创伤性的检查方法 ,能为胆道梗阻的诊治及术后评估提供可靠的依据。     

CT、MRI、MRCP对胆道梗阻的诊断价值

目的　探讨CT、MRI、MRCP对胆道梗阻的诊断价值。方法　分析经病理和临床随访确诊 3 0例 (恶性 2 2例 ,良性 8例 )胆道梗阻患者CT、MRI、MRCP表现。结果　CT、MRI、MRCP对胆道梗阻定位诊断率分别为 86.7%、93 .3 %、10 0 % ,CT、MRI、CT MRI MRCP定性诊断率分别为 80 %、73 %、90 %。结论　综合分析CT、MRI、MRCP表现能提高胆道梗阻的定位、定性诊断率     

MRI诊断恶性胆道梗阻的临床应用分析

目的探讨磁共振胰胆管成像诊断恶性胆道梗阻的临床表现及其与病理结果的对比研究。方法对我院接受诊断与治疗的42例恶性胆道梗阻病变患者采用常规T1WI、T2WI及脂肪抑制T2WI进行检查分析。结果 MRCP结合常规MRI检查对梗阻部位的定位诊断与术中所见一致,其定位诊断准确率达到100.00%(42/42)。本研究42例恶性胆道梗阻患者均成功获得MRCP结合常规MRI检查。本组42例患者经MRCP+MRI和单独MRI的诊断准确率分别为97.62%、73.81%,经统计学分析发现MRCP联合常规MRI较单独MRI检查对恶性胆道梗阻的诊断准确率明显提高,且差异具有统计学意义(2=9.72,P0.05)。MRCP诊断准确率为97.62%。结论磁共振胰胆管成像对恶性胆道梗阻的诊断价值高,不仅可以显示胰胆管病变的形态特征,还可显示病灶邻近结构的关系,提高临床确诊率,对临床治疗决策有指导意义。     

Pancreaticobiliary diseases. Comparison of 2D single-shot turbo spin-echo MR cholangiopancreatography with endoscopic retrograde cholangiopancreatography

PURPOSE: To compare the diagnostic value of MR cholangiopancreatography (MRCP) to that of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of various obstructive and nonobstructive pancreaticobiliary diseases. MATERIAL AND METHODS: We retrospectively reviewed 153 patients who had undergone both MRCP and ERCP Breath-hold, heavily T2-weighted images using 2D single-shot turbo spin-echo technique were obtained. MRCP and ERCP results were correlated with the final clinical diagnoses. Accuracy of MRCP and ERCP in the diagnosis of pancreaticobiliary diseases, detecting the cause and site of biliary obstruction, if present, and distinguishing malignant from benign cause of obstruction were compared. RESULTS: Success rates of MRCP and ERCP were 98.7% and 89.5%, respectively. The accuracy of MRCP and ERCP in detecting the site of biliary obstruction was 89.7% and 96.2%, and in detecting the cause of biliary obstruction 69.2% and 71.8%, respectively. The sensitivity, specificity and likelihood ratios for positive and negative tests for MRCP and ERCP in distinguishing malignant biliary obstruction from benign causes were 86.4%, 82.4%, 4.9, 0.2 and 88.6%, 94.1%, 15.1, 0.1, respectively. Concordance between the two tests was 91% (kappa coefficient 0.82, standard error of kappa 0.113, p<0.001). In the group of nonobstructive biliary diseases, accuracy of MRCP and ERCP in detecting cholecystolithiasis were 100% and 73.7%, and in detecting pancreatitis 57% and 14%, respectively. CONCLUSION: 2D single-shot turbo spin-echo MRCP can be performed as a complement to ERCP and can replace ERCP in high-risk patients and in case of unsuccessful cannulation.     

MR cholangiopancreatography: prospective comparison of a breath-hold 2D projection technique with diagnostic ERCP

The aim of this study was to compare prospectively a breath-hold projection magnetic resonance cholangiopancreatography (MRCP) technique with diagnostic endoscopic retrograde cholangiopancreatography (ERCP). Seventy-six patients with suspected strictures or choledocholithiasis were referred for MRCP and subsequent ERCP examination, which were performed within 4 h of each other. The MRCP technique was performed using fat-suppressed rapid acquisition with relaxation enhancement (RARE) projection images obtained in standardised planes with additional targeted projections as required by the supervising radiologist. Two radiologists (in consensus) assessed the MRCP results prospectively and independently for the presence of bile duct calculi, strictures, non-specific biliary dilatation and pancreatic duct dilatation, and recorded a single primary diagnosis. The ERCP was assessed prospectively and independently by a single endoscopist and used as a gold standard for comparison with MRCP. Diagnostic agreement was assessed by the Kappa statistic. The MRCP technique failed in two patients and ERCP in five. In the remaining 69 referrals ERCP demonstrated normal findings in 23 cases, strictures in 19 cases, choledocholithiasis in 9 cases, non-specific biliary dilatation in 14 cases and chronic pancreatitis in 4 cases. The MRCP technique correctly demonstrated 22 of 23 normal cases, 19 strictures with one false positive (sensitivity 100 %, specificity 98 %), all 9 cases of choledocholithiasis with two false positives (sensitivity 100 %, specificity 97 %), 12 of 14 cases of non-specific biliary dilatation and only 1 of 4 cases of chronic pancreatitis. There was overall good agreement for diagnosis based on a kappa value of 0.88. Breath-hold projection MRCP can provide non-invasively comparable diagnostic information to diagnostic ERCP for suspected choledocholithiasis and biliary strictures and may allow more selective use of therapeutic ERCP. Received: 20 May 1998; Revision received: 26 November 1998; Accepted: 7 January 1999     

Clinical impact of MR cholangiopancreatography in patients with biliary disease

PURPOSE: To evaluate the role of MR Cholangiopan-creatography (MRCP) as a first imaging modality in patients with suspected biliary tree pathology and indications to endoscopic retrograde cholangiopancreatography (ERCP). MATERIAL AND METHODS: Eighty-eight patients, with clinical signs of biliary tree pathology underwent MRCP, performed with a 1.5 T unit and a phased-array coil. Surgery, intraoperative cholangiography, percutaneous transhepatic cholangiography (PTC) or ERCP were regarded as the gold standard in patients with obstruction; the remaining patients underwent follow-up MRCP examinations at 6-9 months. The MR examination was performed with baseline T1w 2D FLASH and T2w TSE sequences, followed by the MRCP study (single-slab breath-hold RARE and multislice breath-hold HASTE sequences). The MR images were independently evaluated by two radiologists. RESULTS: MRCP showed normal findings in 20 patients; 68 patients had biliary duct dilatation. In 11 out of 68 patients MRCP did not identify any obstruction (9/11 were true negative cases). A diagnosis of benign obstruction was expressed in 36/59 patients (4 chronic pancreatitis, 29 choledocolithiasis, 4 inflammatory obstruction, 2 primary sclerosing cholangitis), with 1 false positive and 5 false negatives (sensitivity, specificity and diagnostic accuracy of 86%, 95% and 90%, respectively). MRCP identified 23 neoplastic stenoses (20/23 were true positives): the sensitivity, specificity and diagnostic accuracy values were 100%, 87% and 95%, respectively. MRCP correctly identified the level of obstruction in 100% of cases. CONCLUSIONS: MRCP may be considered as a first-step imaging method in patients with clinical signs of biliary disease. The workload of ERCP in the diagnostic stage could therefore be reduced and its use be reserved for therapeutic indications.     

肝外胆管梗阻的磁共振胆胰管造影诊断

目的 评价磁共振胆胰管造影（ＭＲＣＰ）对肝外胆管梗阻性疾病的临床诊断价值。方法 对５４例肝外胆管梗阻性疾病（肝外胆管结石３０例,恶性胆管梗阻２４例）进行ＭＲＣＰ检查,并与临床诊断或手术和病理结果对照分析。ＭＲＣＰ采用不屏气快速自旋回波（ＴＳＥ）序列重工Ｔ２ＷＩ扫描,结合呼吸触发及脂护抑制技术,原始图像以最大信号强度投影（ＭＩＰ）法进行三维重建。结果 全部５４例ＭＲＣＰ检查均一次成功,５２例胆胰管显     

Navigator-triggered isotropic three-dimensional magnetic resonance cholangiopancreatography in the diagnosis of malignant biliary obstructions: comparison with direct cholangiography

PURPOSE: To compare the diagnostic accuracy of navigator-triggered isotropic three-dimensional (3D) MR cholangiopancreatography (MRCP) using parallel imaging for malignant biliary obstruction with direct cholangiography. MATERIALS AND METHODS: A total of 23 patients with malignant biliary obstruction underwent MRCP and endoscopic retrograde cholangiopancreatography (ERCP)/percutaneous transhepatic cholangiography (PTC). Two observers retrospectively evaluated 3D-MRCP and ERCP/PTC and recorded the level of obstruction and extent of tumor along with their confidence. The quality of images and morphologic appearance of stricture were also evaluated by two reviewers. The results of MRCP and ERCP/PTC were compared with surgical and histopathological data. RESULTS: 3D-MRCP was of diagnostic quality and free of artifacts in all patients, whereas ERCP/PTC examinations failed in three patients. For the evaluation of level of obstruction, there was no statistical significance between 3D-MRCP and ERCP/PTC. 3D-MRCP was superior to ERCP/PTC in the assessment of anatomical extent of hilar bile duct involvement, but did not show statistical significance. The accuracy of 3D-MRCP in determining tumoral extent of hilar cancer was higher than that of ERCP/PTC, but it was not statistically significant. The image quality of 3D-MRCP was superior to ERCP/PTC. There was good agreement between morphologic appearance at MRCP and those at ERCP/PTC. CONCLUSION: 3D-MRCP can accurately assess the level of obstruction and extent of tumor in patients with malignant biliary obstruction.     

Diagnostic value of magnetic resonance cholangiopancreatography in cholestatic jaundice

The aim of the study

To evaluate the diagnostic accuracy of magnetic resonance cholangiopancreatography in patients with cholestatic jaundice.

Patients and methods

Clinical, laboratory and investigational data were evaluated from 50 patients with cholestastic jaundice. MRCP findings were compared with ERCP or operative findings and appropriate clinical endpoints.

Results

The ERCP or operative findings and appropriate clinical endpoints revealed 23 patients with intra or extra hepatic biliary dilatation and 27 patients without intra or extra hepatic biliary dilatation. As regards the 23 patients with biliary dilatation, biliary dilatation was evident in 19 patients by U/S versus 23 patients by MRCP. ERCP was successful in 20 patients (87%) and was not done in three patients (13%). In cases of obstructive jaundice the sensitivity of MRCP was 100% versus 86% in choledocholithiasis and malignant detection, respectively p value <0.05.

Conclusion

MRCP is highly sensitive and specific for biliary dilatation and avoids the need for invasive imaging in most patients with cholestasis. MRCP permits reservation of ERCP to patients with a high probability of therapeutic intervention.     

Clinical applications of magnetic resonance cholangiopancreatography

Magnetic resonance cholangiopancreatography (MRCP) is the most important diagnostic alternative that has been developed in recent years for the evaluation of the biliary and pancreatic ducts. The advantages of this technique are: it does not use contrast media or ionizing radiation; it is noninvasive and complication free; and, the examination is relatively short (approximately 20 to 30 minutes). MRCP has high sensitivity and specificity for diagnosing biliary dilatation and for determining the site and cause of stenosis. Its diagnostic precision for biliary and pancreatic stones is similar to that of endoscopic retrograde cholangiopancreatography (ERCP). MRCP has replaced ERCP in biliary and pancreatic anatomic variants. In unsuccessful ERCP, MRCP is nearly the only diagnostic modality for the evaluation of the biliary tract. Other applications include primary sclerosing cholangitis, stenosis after liver transplantation, and the evaluation of bilioenteric anastomoses. This article reviews the clinical applications of MRCP in the evaluation of biliopancreatic diseases.     

Comparison of endoscopic retrograde cholangiopancreatography with MR cholangiopancreatography in patients with pancreatitis

PURPOSE: To assess the usefulness of magnetic resonance (MR) cholangiopancreatography (MRCP) in the evaluation of disease in patients with acute or chronic pancreatitis. MATERIALS AND METHODS: MR imaging was performed at 1.5 T in 39 patients with chronic (n = 30) or acute (n = 9) pancreatitis. The patients underwent a pancreas MR imaging protocol that included an MRCP sequence. Comparison was made with findings at endoscopic retrograde cholangiopancreatography (ERCP), performed within 30 days. Three blinded readers used a scoring system to evaluate nine segments of the pancreatic and biliary ducts as depicted on the ERCP and MRCP images. MRCP image quality was also evaluated. RESULTS: Of 196 segments analyzed, 17 were not seen at MRCP (sensitivity, 91%). Of the segments visualized at MRCP, 14 were incorrectly characterized (accuracy, 92%). At MRCP, segments not detected or mischaracterized were either normal, slightly dilated, or narrowed. At ERCP, 42 segments in 19 patients were not visualized. MRCP findings were considered useful in all those cases. MRCP image quality was not interpretable in two cases due to artifacts. CONCLUSION: Very good correlation between ERCP and MRCP findings was demonstrated. Both modalities failed to depict pathologic conditions depicted by the alternative method. MRCP may obviate ERCP, particularly in patients who cannot undergo ERCP or in whom ERCP has been unsuccessful.     

Diagnosis of intrahepatic stones: superiority of MR cholangiopancreatography over endoscopic retrograde cholangiopancreatography

OBJECTIVE: The purpose of this study was to compare the efficacy of MR cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) for the diagnosis of intrahepatic stones. MATERIALS AND METHODS: Of the 318 patients who underwent MRCP examinations at our institution during an 18-month period, we identified 49 patients who subsequently underwent surgery or cholangioscopic stone removal with proof of intrahepatic stones. Thirty-four of these patients also underwent ERCP; they made up our study population. All images were interpreted for the presence of bile duct stones: MRCP images were interpreted independently by two reviewers, and ERCP studies were interpreted by one reviewer who was unaware of the MRCP findings. RESULTS: The sensitivity and specificity of MRCP for detecting intrahepatic stones were 97% and 93%, respectively, whereas those of ERCP were 59% and 97%, respectively. MRCP showed a significantly higher sensitivity than ERCP in the diagnosis of intrahepatic stones (p < 0.001). We found no significant difference between MRCP and ERCP in sensitivity or specificity for detecting calculi in the common duct or gallbladder. CONCLUSION: MRCP is a more effective diagnostic method than ERCP for the evaluation of intrahepatic stones.     

Malignant obstructive jaundice: comparison of MRCP and ERCP in the evaluation of distal lesions

PURPOSE: To compare the diagnostic accuracy of MR cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of malignant stenosis of the distal common bile duct. MATERIALS AND METHODS: Twenty-one patients (12 males and 9 females, mean age 62 years) with a clinical suspicion of malignancy of the distal biliary tract and pancreatic head underwent tomographic RM evaluation and diagnostic MRCP, followed by diagnostic and, where possible, therapeutic ERCP. The images obtained with ERCP and MRCP were reviewed blind by two experts who evaluated the presence, site, signal features and locoregional extension of the tumours. Histology performed by brushing or biopsy during ERCP and after surgical resection provided the standard of reference for all 21 patients. RESULTS: CPRM correctly identified the presence and site of the distal biliary stenosis in 21/21 (100%) cases, as well as allowing evaluation of the upper abdomen by associating it with conventional MRI. ERCP, instead, allowed detection of the presence and site of biliary stenosis in 20/21 (95%) cases. DISCUSSION AND CONCLUSIONS: ERCP may have some limitations as regards identification of distal bile duct stenosis in cases of critical stenosis. The non-invasive nature and panoramic capabilities of MRCP and the fact that no contrast material is needed make MRCP the examination of reference in the diagnosis of malignant stenosis of the distal bile duct, also thanks to its ability to visualise the entire biliary tree in the presence of critical strictures of the common bile duct. The rationale for the use of ERCP lies in the possibility of taking histological samples and performing minimally invasive surgical interventions.