磁共振胰胆管造影与内窥镜逆行胰胆管造影在肝移植后人群中的诊断准确性

A. Shiani, S. Lipka, B. Wolk, H. Pinkas, Ambuj Kumar, Angel Alsi-na, N. Kemmer, Alexandra Turner, P. Brady
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引用次数: 1

摘要

简介:磁共振胰胆管造影(MRCP)是评估原位肝移植(OLT)后胆道实验室异常患者的重要诊断工具,以确定是否需要更多侵入性手术,如内镜逆行胰胆管造影(ERCP),它可以提供治疗干预。本研究的目的是在一组olt后患者中,以ERCP作为金标准来确定MRCP结果的诊断准确性。方法:回顾性分析2012年1月至2015年4月在美国佛罗里达州坦帕市南佛罗里达大学和坦帕总医院接受OLT治疗的273例患者。共有52例MRCP患者接受了随后的ERCP研究。记录吻合口狭窄、胆总管扩张>0.7 mm、胆漏、结石、肝内狭窄或肝外狭窄。使用SPSS统计分析软件(version 22 for Windows, SPSS Inc., Chicago, Illinois, USA)计算诊断准确率。结果:调查人群平均年龄为54.5±10.5岁;男性占73%(52例中有38例)。两种方法的总体一致性在71-96%之间。MRCP对吻合口狭窄的敏感性、特异性、阳性预测值和阴性预测值分别为77%、59%、79%和56%。MRCP对>0.7 mm胆总管扩张的敏感性、特异性、阳性预测值和阴性预测值分别为64%、95%、82%和88%。结论:尽管MRCP技术有了显著的进步,可以更好地观察胆道系统,但本研究发现,MRCP在这一特定人群中似乎并不敏感或特异性。应考虑ERCP来确认所有MRCP阳性的发现,在MRCP正常的病例中,如果有其他临床数据提示胆道异常。
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Diagnostic Accuracy of Magnetic Resonance Cholangiopancreatography Versus Endoscopic Retrograde Cholangiopancreatography Findings in the Postorthotopic Liver Transplant Population
Introduction: Magnetic resonance cholangiopancreatography (MRCP) is an important diagnostic tool in evaluating patients with biliary laboratory abnormalities after orthotopic liver transplant (OLT) to determine the need for more invasive procedures, such as endoscopic retrograde cholangiopancreatography (ERCP), which can deliver therapeutic interventions. The aim of this study was to determine the diagnostic accuracy of MRCP findings using ERCP as the gold standard in a group of post-OLT patients. Methods: A retrospective review of 273 patients who underwent OLT at the University of South Florida and Tampa General Hospital, Tampa, Florida, USA, from January 2012–April 2015 was performed. A total of 52 patients who had a MRCP and underwent a subsequent ERCP were studied. Presence of anastomotic stricture, common bile duct dilation >0.7 mm, bile leak, stone, intrahepatic stricture, or extrahepatic stricture on either modality was recorded. SPSS statistical analysis software (version 22 for Windows, SPSS Inc., Chicago, Illinois, USA) was used to calculate diagnostic accuracy. Results: The mean age of the population examined was 54.5±10.5 years; 73% of the patients were male (38 of 52). Overall agreement between the two procedures ranged from 71–96%. The sensitivity, specificity, and positive and negative predictive values of MRCP for anastomotic strictures were 77%, 59%, 79%, and 56%, respectively. The sensitivity, specificity, and positive and negative predictive values of MRCP for common bile duct dilation of >0.7 mm were 64%, 95%, 82%, and 88%, respectively. Conclusion: Despite significant improvement in the technology to better visualise the biliary system on MRCP, this study found that MRCP does not appear to be sensitive or specific in this chosen population. ERCP should be considered to confirm all positive MRCP findings, and in normal MRCP cases if there are other clinical data suggesting biliary abnormalities.
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