CAJ | 학술논문

目的探讨胰泌素增强磁共振胰胆管成像(S-M RC P )在提高主胰管和分支胰管的可视化程度 ,分级诊断慢性胰腺炎(C P )的价值.方法前瞻性分析88例受试者(健康志愿者23例 ,C P者65例)的3 .0 T磁共振影像学资料.所有受试者均在未注射胰泌素和静脉注射0 .1 mL/kg胰泌素后行多期磁共振胰胆管成像(MRCP)、冠状位T2WI扫描、常规胰腺平扫和增强扫描.65例CP患者按照剑桥分级法进行分组 ,并按照十二指肠充盈正常和异常进行分组.比较注射胰泌素前后主胰管、分支胰管、十二指肠充盈的情况.最后将各项结果与金标准内镜逆行胰胆管造影(ERCP)结果进行对照.健康对照组和CP各组间各项指标间比较采用单因素方差分析 ,十二指肠充盈正常组和异常组间各指标比较采用卡方检验.MRCP、S-MRCP 分级诊断结果与 ERCP 结果一致性判定采用 Kappa 检验.结果与M RC P相比 ,在注射胰泌素后主胰管各项评估指标和分支胰管显示的敏感度、特异度、阳性预测值和阴性预测值均有提高 ,误诊率、漏诊率均有所降低.以ERCP分级诊断CP为金标准 ,S-M RCP诊断CP的一致性(Kappa=0 .77 ,P=0 .000 1)较MRCP明显提高(Kappa=0 .55 ,P=0 .000 1).43例十二指肠充盈正常组中在主胰管扩张、充盈缺损、胰头分支胰管显示分别为28、23、30例 ,而22例异常组分别为20、19、21例 ,差异均有统计学意义(χ2 =5 .01、3 .91、6 .88、4 .26 ,P<均0 .05 ).将达峰时间4 min作为临界值 ,其诊断C P的敏感度为86 .0% ,特异度为100 .0% .结论 S-M RC P提高了对主胰管和分支胰管的可视化程度 ,提高了对CP分级诊断的准确性.
목적 탐토이비소증강자공진이담관성상(S-M RC P )재제고주이관화분지이관적가시화정도 ,분급진단만성이선염(C P )적개치.방법 전첨성분석88례수시자(건강지원자23례 ,C P자65례)적3 .0 T자공진영상학자료.소유수시자균재미주사이비소화정맥주사0 .1 mL/kg이비소후행다기자공진이담관성상(MRCP)、관상위T2WI소묘、상규이선평소화증강소묘.65례CP환자안조검교분급법진행분조 ,병안조십이지장충영정상화이상진행분조.비교주사이비소전후주이관、분지이관、십이지장충영적정황.최후장각항결과여금표준내경역행이담관조영(ERCP)결과진행대조.건강대조조화CP각조간각항지표간비교채용단인소방차분석 ,십이지장충영정상조화이상조간각지표비교채용잡방검험.MRCP、S-MRCP 분급진단결과여 ERCP 결과일치성판정채용 Kappa 검험.결과 여M RC P상비 ,재주사이비소후주이관각항평고지표화분지이관현시적민감도、특이도、양성예측치화음성예측치균유제고 ,오진솔、루진솔균유소강저.이ERCP분급진단CP위금표준 ,S-M RCP진단CP적일치성(Kappa=0 .77 ,P=0 .000 1)교MRCP명현제고(Kappa=0 .55 ,P=0 .000 1).43례십이지장충영정상조중재주이관확장、충영결손、이두분지이관현시분별위28、23、30례 ,이22례이상조분별위20、19、21례 ,차이균유통계학의의(χ2 =5 .01、3 .91、6 .88、4 .26 ,P<균0 .05 ).장체봉시간4 min작위림계치 ,기진단C P적민감도위86 .0% ,특이도위100 .0% .결론 S-M RC P제고료대주이관화분지이관적가시화정도 ,제고료대CP분급진단적준학성.
Objective To investigate effect of secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) on visualization improvement of main and branch pancreatic duct and its diagnostic value of grading chronic pancreatitis (CP) .Methods The 3 .0 T magnetic resonance (MR) imaging data of 88 subjects (23 health volunteers and 65 CP patients) were prospectively analyzed .All the subjects received coronal T2-weighted sequences scan ,thick slab 2-dimensional MRCP sequences scan , routine pancreas plain scan and enhanced scan before and after 0 .1 mL/kg secretin intravenous injection . Sixty-five CP patients were grouped according to Cambridge classification and also according to normal and abnormal of duodenal filling (DF) .The images of main pancreatic duct (MPD) ,branch pancreatic duct (BPD) and DF were compared before and after secretin injection .The result was compared with that of endoscopic retrograde cholangio pancreatography (ERCP) which was the gold standard .One-way analysis of variance test was performed for comparison between healthy control group and CP group .Chi-square test was used for comparison between normal DF group and abnormal DF group .The consistence between the diagnostic results of MRCP ,S-MRCP and the results of ERCP were analyzed by Kappa test .Results Compare with MRCP ,after secretin injection the indexes of MPD ,the sensitivity ,specificity ,positive predictive value and negative predictive value of BPD were all improved ,and the rates of misdiagnosis and missed diagnosis all decreased .Using ERCP as gold standard of CP grade diagnosis ,the consistence of S-MRCP in CP grade diagnosis increased more significantly (Kappa=0 .77 ,P=0 .000 1) compared with that of MRCP (Kappa=0 .55 ,P=0 .000 1) .Among 43 normal DF cases ,the number of MPD dilatation , filling defect and branch duct in pancreatic head was 28 ,23 and 30 ,respectively ;among 22 abnormal DF cases which was 20 ,19 and 21 ,respectively ,and the differences were statistically significant (χ2=5 .01 , 3 .91 ,6 .88 and 4 .26 ,all P<0 .05) .Taking 4 min as the cutoff value of peak time ,the sensitivity and specificity of which in CP diagnosis were 86 .0% and 100 .0% , respectively . Conclusion S-MRCP improves the visualization of MPD and BPD ,and also increases the accuracy of CP grade diagnosis .