胆管疾患診断におけるMRCPの臨床的意義  [in Japanese] Clinacal efficacy of magnetic resonance cholangiopancreatography in the diagnosis of biliary tract diseases  [in Japanese]

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Abstract

胆管疾患診断に対するMRCPの臨床的意義について検討した.ERCP施行311例を対象にMRCPを併施し,ERCP所見にブラインドでMRCP像を読影した.胆管描出率は99%でERCPより高率であった.胆管結石診断能は感度95%,特異度97%,正診率97%と良好な結果であった.微小結石は診断困難であった.胆管狭窄存在診断能は感度97%,特異度96%,正診率96%であった.胆管末端の狭窄の描出は困難であった.MRCPは胆管病変疑診例に対し精度の高い診断法として,受診後早期に施行されるべきであるが,読影には特有のpitfallに注意が必要である.

This study was carried out to clarify the efficacy of magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of biliary tract diseases, Three hundred and eleven patients who underwent MRCP and ERCP during the period from January 1999 to Decomber 1999 at our institution were included in the study. Two gastroenterologists who were blinded to results of direct cholangiograhy and final diagnoses interpreted MRCP images prospectively. The biliary duct was visualized by MRCP and ERCP in 99.4% and 89.5% of the cases, respectively. The sensitivity, specificity, and accuracy of MRCP in the diagnosis of choledocholithiasis were 95%, 97%, and 97%, respectively. MRCP depicted the presence of strictures with a sensitivity, specificity, and accuracy of 97%, 96%, and 96%, respectively. There were three false-positive cases because of artifacts from arterial compression, The accuracy of MRCP and ERCP in differentiation of benign strictures from malignant ones was 85% and 96%, respectively.<BR> Based on these results, it is concluded that MRCP has high capability in visualization of the biliary tree, and in detection of stones and strictures, To avoid over and under-diagnosis, awareness of some pitfalls inherent in, MRCP is important.<BR> We suggest that MRCP should be recommended for patients with suspicion of biliary tract diseases in the initial stage of making diagnosis.

Journal

  • Nippon Shokakibyo Gakkai Zasshi

    Nippon Shokakibyo Gakkai Zasshi 98(10), 1164-1173, 2001-10-05

    The Japanese Society of Gastroenterology

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