术前MRI T2WI及MRCP诊断胆总管结石的临床价值
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摘要
目的探究术前磁共振成像(MRI T2WI及磁共振胰胆管成像(MRCP)诊断胆总管结石的临床价值。方法选择2015年12月至2017年12月我院收治的疑似胆总管结石患者作为研究对象,所有患者在行经内镜逆行性胰胆管造影术(ERCP)及取石术检查前2周内进行MRIT2WI序列检查及MRCP检查,以ERCP诊断及术中所见作为金标准,分析T2WI及MRCP两种方法诊断胆总管结石的准确性、灵敏度、误诊率、漏诊率。结果 MRIT2WI序列诊断胆总管结石的敏感度、误诊率、漏诊率、准确率分别为97.53%、2.43%、3.70%、96.34%;MRCP方法对胆总管结石敏感度、误诊率、漏诊率、准确率分别为87.65%、0.00%、12.34%、87.80%;MRCP诊断漏诊率高于T2WI序列,差异具统计学意义(P<0.05)。结论 MRCP对泥沙样结石及单发小结石漏诊率较高,对胆总管小结石的诊断效能不及T2WI序列。
Objective To investigate the clinical value of preoperative magnetic resonance imaging(MRI) T2 WI and magnetic resonance cholangiopancreatography(MRCP) in the diagnosis of common bile duct stones. Methods Patients with suspected common bile duct stones who admitted to the hospital from December 2015 to December 2017 were selected as subjects. All patients underwent MRI T2 WI examination and MRCP within 2 weeks before endoscopic retrograde cholangiopancreatography(ERCP) and stone removal. With ERCP diagnosis and intraoperative findings as the golden standard,the accuracy rates, sensitivities, misdiagnosis rates and missed diagnosis rates of T2 WI and MRCP in diagnosis of common bile duct stones were analyzed. Results The sensitivity,missed diagnosis rate and accuracy rate of MRI T2 WI for diagnosis of common bile duct stones were 97.53%, 2.43%, 3.70% and 96.34%, respectively, while those of MRCP were87.65%, 0.00%, 12.34% and 87.80%, respectively. The missed diagnosis rate of MRCP was significantly higher than that of T2 WI(P<0.05). Conclusion The missed diagnosis rate of MRCP is high for ediment-like stones and solitary small stones, and the diagnostic efficiency for common bile duct stones is inferior to that of T2 WI.
Objective To investigate the clinical value of preoperative magnetic resonance imaging(MRI) T2 WI and magnetic resonance cholangiopancreatography(MRCP) in the diagnosis of common bile duct stones. Methods Patients with suspected common bile duct stones who admitted to the hospital from December 2015 to December 2017 were selected as subjects. All patients underwent MRI T2 WI examination and MRCP within 2 weeks before endoscopic retrograde cholangiopancreatography(ERCP) and stone removal. With ERCP diagnosis and intraoperative findings as the golden standard,the accuracy rates, sensitivities, misdiagnosis rates and missed diagnosis rates of T2 WI and MRCP in diagnosis of common bile duct stones were analyzed. Results The sensitivity,missed diagnosis rate and accuracy rate of MRI T2 WI for diagnosis of common bile duct stones were 97.53%, 2.43%, 3.70% and 96.34%, respectively, while those of MRCP were87.65%, 0.00%, 12.34% and 87.80%, respectively. The missed diagnosis rate of MRCP was significantly higher than that of T2 WI(P<0.05). Conclusion The missed diagnosis rate of MRCP is high for ediment-like stones and solitary small stones, and the diagnostic efficiency for common bile duct stones is inferior to that of T2 WI.
引文
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[9]张昊,高黎黎,薛冰,等.经内镜逆行性胰胆管造影选择性插管困难的影响因素研究[J].中国全科医学,2018,8(14):95-97.
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[13]杨星,刘巍,邓小明,等.术前MRCP与LC术中胆道造影诊断胆囊结石合并可疑胆总管结石的临床价值比较[J].重庆医学,2016,45(15):2070-2072.
[2]张东坡,李建军,戴定可,等.恶性梗阻性黄疸PTBD对免疫功能影响的前瞻性对照研究[J].罕少疾病杂志,2015, 22(4):23-27.
[3]姚利,陈先祥,涂华华,等.内镜逆行性胰胆管造影术与腹腔镜胆总管探查术治疗胆嚢切除术后胆总管结石的疗效比较[J].临床外科杂志,2018, 5(2):26-27.
[4]胡剑峰,申爱强,丁洪彬.MRI多序列结合MRCP对肝内胆管结石并胆道梗阻的诊断价值[J].中国CT和MRI杂志,2016,14(12):83-84.
[5]卢加杰,高峰,阿依努尔&#;阿合曼,等.溃疡性结肠炎与无症状胆结石的关系及危险因素分析[J].胃肠病学和肝病学杂志,2016,25(10):1136-1140.
[6]胡晓,陈子洋.ERCP联合MRI在诊断胰胆管疾病中临床价值[J].中国CT和MRI杂志,2016, 14(9):65-67.
[7] Kolodziejczyk E,Jurkiewicz E,Pertkiewicz J,et al.MRCP Versus ERCP in the Evaluation of Chronic Pancreatitis in Children:Which Is the Better Choice[J]. Pancreas, 2016,45(8):1115.
[8]王秀玲,李卫华,莫庆,等.磁共振胰胆管水成像联合动态增强MR在鉴别胆道良恶性梗阻中的价值[J].实用临床医药杂志,2 01 7, 5(2 3):1 2 9-131.
[9]张昊,高黎黎,薛冰,等.经内镜逆行性胰胆管造影选择性插管困难的影响因素研究[J].中国全科医学,2018,8(14):95-97.
[10]Chen, Jing-Jia,Chao-Qun,e t al. Diagnostic value of magnetic resonance cholangiopancreatography in choledocholithiasis[J].World Journal of Gastroenterology,2015,21(11):3351-3360.
[11] L i P, Zhang Z,Li J, e t al. Diagnostic value of magnetic resonance cholangiopancreatography for secondary common bile duet atones compared with laparoscopic transcystic common bile ductexploration[J]. Med Sci Moni t,2014, 20(27):920-926.
[12]Aydelotte J D,Ali J,Huynh P T,et a l. Use of Magnetic Resonance Cholangiopancreatography in Clinical Practice:Not as Good as We Once Thought[J]. Journal of the American College of Surgeons,2015, 221(1):215-219.
[13]杨星,刘巍,邓小明,等.术前MRCP与LC术中胆道造影诊断胆囊结石合并可疑胆总管结石的临床价值比较[J].重庆医学,2016,45(15):2070-2072.