胰泌素增强磁共振胰胆管造影对88例慢性胰腺炎患者胰管评估的价值  

Assessment value of secretin-enhanced magnetic resonance cholangiopancreatography in the pancreatic duct of 88 patients with chronic pancreatitis

作　　者：边云[1] 杨学东 胡良皞[2] 田冰[1] 陈士跃[1] 陆建平[1] 王莉[1] 

机构地区：[1]长海医院影像科,上海200433 [2]长海医院消化科,上海200433 [3]解放军第四一一医院影像科

出　　处：《中华消化杂志》2015年第10期682-686,共5页Chinese Journal of Digestion

基　　金：国家自然科学基金（81070371）;国家青年科学基金（81300366）;上海市虹口区卫生和计划生育委员会科研课题计划（虹卫140212）

摘　　要：目的探讨胰泌素增强磁共振胰胆管成像（S-MRCP）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（CP）的价值。方法前瞻性分析88例受试者（健康志愿者23例，CP者65例）的3．0T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0．1mL／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昔方检验。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MRCP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-MRCP诊断CP的一致性（Kappa=0．77，P=0．0001）较MRCP明显提高（Kappa=0．55，P=0．0001）。43例十二指肠充盥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、l9、21例，差异均有统计学意义（χ^2=5．01、3．91、6．88、4．26，P〈均0．05）。将达峰时间4min作为临界值，其诊断CP的敏感度为86．0％，特异度为100．0％。结论S-MRCP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。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 （χ^2

关 键 词：胰胆管造影术 磁共振 胰胆管造影术 内镜逆行 胰腺炎 慢性 

分 类 号：R576[医药卫生—消化系统] R816.5[医药卫生—内科学]