Sensitivity of Endoscopic Ultrasound, Multidetector Computed Tomography, and Magnetic Resonance Cholangiopancreatography in the Diagnosis of Pancreas Divisum A Tertiary Center Experience
Sensitivity of Endoscopic Ultrasound, Multidetector Computed Tomography, and Magnetic Resonance Cholangiopancreatography in the Diagnosis of Pancreas Divisum A Tertiary Center Experience
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DOI：
10.1097/mpa.0b013e31826c711a
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发表时间：
2013-04-01
期刊：
影响因子：
2.9
通讯作者：
Azar, Riad R.
中科院分区：
文献类型：
--
作者：
Kushnir, Vladimir M.;Wani, Sachin B.;Azar, Riad R.
目的：胰腺分裂的影像学诊断资料有限。我们的目标是：（1）评价内镜超声（EUS）、磁共振胰胆管造影（MRCP）和多层螺旋CT（MDCT）对胰腺分裂的敏感性;（2）评价放射科专家在MDCT和MRCP上检测胰腺分裂的观察者间一致性（IOA）。在这项回顾性队列研究中，我们确定了45例连续的胰胆管症状和胰腺分裂的患者，这些患者通过内镜逆行胰管造影术进行了EUS检查和横截面成像。结果：EUS诊断胰腺分裂的敏感性为86.7%，显著高于文献报道的MDCT（15.5%）和MRCP（60%）（P < 0.001）。经放射科专家审查，在胰管可视化的病例中，MDCT的灵敏度增加到83.3%，IOA中等（kappa = 0.34）。MRCP的专家评审未发现任何额外的胰腺分裂病例; IOA为中度（kappa = 0.43）。结论：内镜超声是诊断胰腺分裂的敏感试验，上级MDCT和MRCP。放射科专家对MDCT研究的回顾大大提高了其对胰腺分裂的敏感性。
Objectives: There are limited data comparing imaging modalities in the diagnosis of pancreas divisum. We aimed to: (1) evaluate the sensitivity of endoscopic ultrasound (EUS), magnetic resonance cholangio-pancreatography (MRCP), and multidetector computed tomography (MDCT) for pancreas divisum; and (2) assess interobserver agreement (IOA) among expert radiologists for detecting pancreas divisum on MDCT and MRCP.Methods: For this retrospective cohort study, we identified 45 consecutive patients with pancreaticobiliary symptoms and pancreas divisum established by endoscopic retrograde pancreatography who underwent EUS and cross-sectional imaging. The control group was composed of patients without pancreas divisum who underwent endoscopic retrograde pancreatography and cross-sectional imaging.Results: The sensitivity of EUS for pancreas divisum was 86.7%, significantly higher than the sensitivity reported in the medical records for MDCT (15.5%) or MRCP (60%) (P < 0.001 for each). On review by expert radiologists, the sensitivity of MDCT increased to 83.3% in cases where the pancreatic duct was visualized, with fair IOA (kappa = 0.34). Expert review of MRCPs did not identify any additional cases of pancreas divisum; IOA was moderate (kappa = 0.43).Conclusions: Endoscopic ultrasound is a sensitive test for diagnosing pancreas divisum and is superior to MDCT and MRCP. Review of MDCT studies by expert radiologists substantially raises its sensitivity for pancreas divisum.