三维磁共振胰胆管成像诊断小儿胆道闭锁价值分析

doi:10.3969/j.issn.1672-5069.2021.02.035

摘要/Abstract

摘要： 目的研究磁共振成像(MRI)三维磁共振胰胆管成像(3D-MRCP)诊断小儿胆道闭锁(BA)的临床价值。方法 2016年4月～2020年4月我院收治的疑似BA患儿24例,接受常规MRI和3D-MRCP检查。对患儿采取Kasai术,以手术后组织病理学检查结果为金标准,判断3D-MRCP诊断BA的效能。结果 24例疑似BA患儿均顺利完成手术,术后组织病理学检查诊断BA 22例(91.7%),其中包括胆总管闭锁(Ⅰ型)2例(8.3%),肝总管闭锁(Ⅱ型)2例(8.3%),肝门部胆管闭锁(Ⅲ型)18例(75.0%);胆总管囊肿1例(4.2%)和胆道系统正常1例(4.2%);3D-MRCP准确诊断BA 21例,胆总管囊肿1例,把胆总管闭锁(Ⅰ型)漏诊为胆总管囊肿1例,把婴儿肝炎综合征胆道正常患儿误诊为BA 1例;3D-MRCP诊断BA的灵敏度为95.5%,特异度为50.0%,准确率为95.8%,阳性预测值为95.5%,阴性预测值为50.0%,与手术后组织病理学诊断的一致性检验的Kappa值为0.455(P＜0.05)。结论 3D-MRCP对BA具有较高的诊断效能,可帮助临床医生做出早期诊断。

关键词: 胆道闭锁, 三维磁共振胰胆管成像, 诊断

Abstract: Objective The aim of this study was to investigate the clinical value of three-dimensional magnetic resonance cholangiopancreatography (3D-MRCP) in the diagnosis of infantile biliary atresia (BA).Methods 24 children with suspected BA were admitted to our hospital between April 2016 and April 2020, and all underwent routine MRI and 3D-MRCP examination. The diagnostic efficacy of MRCP was evaluated by histopathological examination as a gold standard.Results 24 children with suspected BA were successfully completed surgery, andthe pathological examination showed BA in 22 (91.7%)children, including BA type Ⅰ in 2 (8.3%), BA type Ⅱ in2(8.3%) and type Ⅲ in 18(75.0%), choledochal cyst in 1 (4.2%) and normal biliary system in 1(4.2%); the 3D-MRCPdiagnosed BA in 21, choledochal cyst in 1, while misdiagnosed BA as choledochal cyst in 1, and misdiagnosed infantile hepatitis syndrome with normal biliary tract system as BA in 1; the sensitivity of 3D-MRCP in the diagnosis of BA was 95.5%, with the specificity of 50.0%, the accuracy of 95.8%,the positive predictive value of 95.5%, the negative predictive value of 50.0%, and the Kappa value of consistency with pathological diagnosis was 0.455 (P<0.05).Conclusion The application of 3D-MRCP has a high diagnostic efficiency for infants with BA, which could guide the clinicians dealing with this entity appropriately early.

Key words: Biliary atresia, Three-dimensional magnetic resonance cholangiopancreatography, Diagnosis

宋斌, 赵厚亮, 叶莉. 三维磁共振胰胆管成像诊断小儿胆道闭锁价值分析[J]. 实用肝脏病杂志, 2021, 24(2): 288-291.

Song Bin, Zhao Houliang, Ye Li. Application of three-dimensional magnetic resonance cholangiopancreatography in diagnosis of biliary atresia in children[J]. Journal of Practical Hepatology, 2021, 24(2): 288-291.

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