简体中文

论著-头颈部

术前MRI T2WI及 MRCP诊断胆总管结 石的临床价值*

作者:杨文义 武利萍 闫 春 王航宇 谭莉霞 董 勇 杨国威 华 静 杜莹莹

所属单位:河南大学第一附属医院消化内科 (河南 开封 475001)

PDF

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MRI T2WI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 MRI T2WI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) T2WI 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 T2WI 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 T2WI and MRCP in diagnosis of common bile duct stones were analyzed. Results The sensitivity, missed diagnosis rate and accuracy rate of MRI T2WI for diagnosis of common bile duct stones were 97.53%, 2.43%, 3.70% and 96.34%, respectively, while those of MRCP were 87.65%, 0.00%, 12.34% and 87.80%, respectively. The missed diagnosis rate of MRCP was significantly higher than that of T2WI (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 T2WI.

【关键词】磁共振成像;T2WI;磁共振胰 胆管成像;胆总管结石

【中图分类号】R25;R73

【文献标识码】A

【DOI】10.3969/j.issn.1672- 5131.2019.04.028

前言

胆道结石是临床常见病、多发病,较为严重的胆总管结石可引发 胆管梗阻,胆汁淤积从而继发感染,造成梗阻性胆管炎、胆源性胰腺 炎、胆源性肝脓肿等严重病症,危害患者健康,因此,胆管结石需及 时诊断及手术治疗[1-2]。目前胆总管结石常见的影像学检查方法包括超 声、CT、磁共振成像(MRI)及经内镜逆行性胰胆管造影术(ERCP)等。其 中超声易受肠道气体影响;CT对于高密度结石可明确诊断,但对于等 密度或低密度结石诊断尚较为困难;ERCP被认为是胰胆管疾病诊断的 金标准,但其为有创性检查,多用于结石术中的探查[3]。研究证实, MRI多序列成像在诊断胆总管结石上均有较高的准确率,其中磁共振胰 胆管成像(MRCP)可在无对比剂情况下进行检查[4]。本研究回顾性分析 82例术前经MRI及MRCP诊断检查的胆总管结石患者的影像学资料,与术 中ERCP所见进行对比,分析两种方法的诊断效能及价值。