肝胆动态显像与磁共振胆胰管成像在胆道闭锁诊断中的价值

【目的】探讨肝胆动态显像与磁共振胆胰管成像（MRCP）在胆道闭锁诊断中的价值。【方法】192例临床怀疑胆道闭锁的患者行肝胆动态显像及MRCP，两种检查在手术前全部完成。肝胆显像有胆道闭锁征象，即认为阳性（胆道闭锁），反之即认为阴性（除外胆道闭锁）；MRCP有胆道闭锁征象，即认为阳性（胆道闭锁），反之即认为阴性（除外胆道闭锁）。【结果】病理证实145例患者为胆道闭锁，47例为非胆道闭锁，其中新生儿肝炎20例，胆总管囊肿22例，其他肝脏病变5例。肝胆显像假阴性率和假阳性率分别为：40．9％和12．1％；MRCP假阴性率和假阳性率分别为：38．6％和9．5％。肝胆显像和MRCP的假阴性率和假阳性率之间无统计学差异。MRCP诊断结果与病理结果不符合的共41例，占21．4％；在41患者中，肝胆显像结果与病理结果符合的24例，占58．5％。单独应用MRCP符合率为78．65％，单独应用肝胆显像符合率为78．13％；MRCP联合肝胆显像总符合率为91．15％，与前两者相比有统计学差异。【结论】肝胆显像和MRCP在胆道闭锁的假阴性率和假阳性率之间无统计学差异，但联合应用可以提高胆道闭锁的诊断准确率。

Combined Application of Hepatobiliary Scintigraphy and Magnetic Resonance Cholangiopancreatography in Biliary Atresia

Objective] To evaluate the diagnostic value of hepatohiliary seintigraphy （HBS） and magnetic reso nance cholangiopanereatography （MRCP） in biliary atresia and combined application of HBS and MRCP. Methods] A total of 192 inpatients with suspected biliary atresia performed HI：kS and MRCP examinations before surgery. All images were analyzed visually. If there was the sign of biliary atresia on HBS and MRCP, this case was considered as positive case （i. e. biliary atresia case）. Otherwise, this case was considered as negative case （i. e. non-biliary atresia case）. Results]A total of 145 patients were proven to be biliary atresia by pathology and 47 patients were non biliary atresia cases. The false-positive and false-negative of HtLS were 40.9 % and 12.1%, respectively. The false-positive and false-negative of MRCP was 38.6% and 9.5%, respectively. There was no significant difference between false- positive and false-negative of HBS and MRCP. The MRCP results of 41 patients, occupying 21.4% in all patients, were false contrasted with pathological results, but HBS results of 24 patients, occupying 58. 5%, were identical contrasted with pathological results. The coincidence rate of single MRCP and HBS was 78.65% and 78.13%, re- spectively. The coincidence of combined application of HBS and MRCP was 91. 15%, and there was significant difference between combined application and single application. Conclusion] There is no significant difference in false-positive and false-negative between HBS and MRCP, hut combined application of HBS and MRCP can enhance the correct diagnosis rate of biliary atresia.