Hepatobiliyer Hastalıklarda Tanıya Yönelik Görüntüleme Yöntemlerinden Endoskopik Retrograd Kolanjiopankreatografi ve Manyetik Rezonans Kolanjiopankreatografinin Etkinliğinin Karşılaştırılması

Yıl 2021, , 116 - 121, 31.12.2020

Ahmed Ramiz Baykan , Tahir Buran , Emre Gerçeker , Hakan Yüceyar , Serdar Tarhan , Elmas Kasap , Gökhan Pekindil

https://doi.org/10.34087/cbusbed.826927

Öz

Amaç: Manyetik rezonans kolanjiopankreatografinin tanıya yönelik etkinliğini tanıda altın standart olarak kabul edilen endoskopik retrograd kolanjiopankreatografi ile kıyaslayarak değerlendirmeyi planladık.
Gereç ve yöntem: Celal Bayar Üniversite hastanesi gastroenteroloji kliniğine 2012-2014 yılları arasında başvurup, Manyetik rezonans kolanjiopankreatografi ve sonrasında endoskopik retrograd kolanjiopankreatografi yapılan hastaların dosyaları retrospektif olarak incelendi
Bulgular: Çalışmaya 53 erkek, 57 kadın toplam 110 hasta dâhil edildi. Hastaların ortalama yaşı 63,56±16,897 olarak saptandı. Endoskopik retrograd kolanjiopankreatografi altın standart olarak alındığında ve kanülasyon sağlanamayan hastalar çıkarıldığında koledokolitizis için manyetik rezonans kolanjiopankreatografinin sensitivitesi (%66,6), spesifitesi (%82,8) olarak saptandı. Manyetik rezonans kolanjiopankreatografinin pozitif prediktif değeri (%86,9), negatif prediktif değeri (%59,1) olarak saptandı. 5 mm ve büyük taşlar dikkate alındığında, manyetik rezonans kolanjiopankreatografinin duyarlılığının %91,9’ a çıktığı görüldü. Hepatobiliyer malignitelerde, manyetik rezonans kolanjiopankreatografinin sensitivitesi (%69,56), spesifitesi (%100) olarak saptandı. Manyetik rezonans kolanjiopankreatografinin hepatobiliyer maligniteler için pozitif prediktif değeri (%100), negatif prediktif değeri (%91,13) olarak saptandı.
Sonuç: Hepatobiliyer hastalıkların tanısını koymada göstermiş olduğu yüksek sensitivite ve spesifite değerleri nedeni ile manyetik rezonans kolanjiopankreatografi, günümüzde tanı alanında endoskopik retrograd kolanjiopankreatografinin yerini büyük ölçüde almıştır. Teknolojinin gelişmesi ile birlikte daha iyi görüntü kalitesi sonucu tanı alanında bu etkinliğinin daha çok büyümesi beklenmektedir

Anahtar Kelimeler

Endoskopik retrograd kolanjiopankreatografi, Manyetik rezonans kolanjiopankreatografi, Safra yolu taşı

Comparison of the Effectiveness of Endoscopic Retrograde Cholangiopancreatography and Magnetic Resonance Cholangiopancreatography as Diagnostic Imaging Methods in Hepatobiliary Diseases

Öz

Objective: To evaluate the diagnostic effectiveness of magnetic resonance cholangiopancreatography by comparing it with endoscopic retrograde cholangiopancreatography, which is considered the gold standard in diagnosis.
Material and Methods: The results of patients who applied to the celal bayar university hospital gastroenterology clinic between 2012-2014 and who performed magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography were analyzed retrospectively.
Results: The study included a total of 110 patients (53 males and 57 females). The mean age of the patients was 63.56 ± 16.897 years. When endoscopıc retrograde cholangiopancreatography was taken as the golden standard and after patients with failed cannulation were excluded, the sensitivity and specificity of magnetic resonance cholangiopancreatography in the diagnosis of choledocholithiasis were determined as 66.6% and 82.8%, respectively. The positive predictive value of magnetic resonance cholangiopancreatography was 86.9% and the negative predictive value was 59.1%. For gallstones ≥ 5 mm, the sensitivity of magnetic resonance cholangiopancreatography increased to 91.9%. For hepatobiliary malignancies, the sensitivity and specificity of magnetic resonance cholangiopancreatography were determined to be 69.56% and 100%, respectively, and the positive predictive value was 100% and negative predictive value was 91.13%.
Conclusion: Magnetic resonance cholangiopancreatography is a widely used imaging method in the diagnosis of hepatobiliary system diseases. Although it is very effective in the diagnosis of malignant diseases and bile duct stones larger than 6mm, its diagnostic value decreases in the detection of small bile duct stones

Anahtar Kelimeler

Endoscopic retrograde cholangiopancreatography, Gallstone, Magnetic resonance

Kaynakça

• 1. Albert JG, Riemann JF. ERCP and MRCP - When and why. Bailliere’s Best Pract Res Clin Gastroenterol. 2002;16(3):399–419.
• 2. Wallner BK, Schumacher KA, Weidenmaier W, Friedrich JM. Dilated biliary tract: Evaluation with MR cholangiography with a T2- weighted contrast-enhanced fast sequence. Radiology. 1991;181(3):805–8.
• 3. Ceylan G, Yavaşcaoğlu B, Korfali G, Fatma N, Kaya B, Moğol G, et al. Endoskopik Retrograd Kolanjiopankreatografi İşlemi İçin Bilinçli Sedasyon Uygulamasında Propofol ile Deksmedetomidinin Hemodinami ve Kognitif Fonksiyonlara Etkisinin Karşılaştırılması. Vol. 36, Uludağ Üniversitesi Tıp Fakültesi Dergisi. 2010.
• 4. Kaltenthaler EC, Walters SJ, Chilcott JB, Blakeborough A, Vergel YB, Thomas SM. MRCP compared to diagnostic ERCP for diagnosis when biliary obstruction is suspected: A systematic review. Vol. 6, BMC Medical Imaging. BMC Med Imaging; 2006.
• 5. Dursun HB, Yılmaz E. BATIN CERRAHİSİ YAPILAN HASTALARIN ÖĞRENİM GEREKSİNİMLERİ. Vol. 2, Sağlık Bilimleri Enstitüsü Dergisi. 2015 Sep.
• 6. Varghese JC, Farrell MA, Courtney G, Osborne H, Murray FE, Lee MJ. A prospective comparison of magnetic resonance cholangiopancreatography with endoscopic retrograde cholangiopancreatography in the evaluation of patients with suspected biliary tract disease. Clin Radiol. 1999;54(8):513–20.
• 7. Jara H, Barish MA, Yucel EK, Melhem ER, Hussain S, Ferrucci JT. MR hydrography: Theory and practice of static fluid imaging. Vol. 170, American Journal of Roentgenology. American Roentgen Ray Society; 1998. p. 873–82.
• 8. Vaníček J, Kyselová H, Kianička B, Mikulicová R, Bajgarová B, Trna J, et al. [Comparison of MRCP a ERCP in diagnosis of choledocholithiasis]. Vnitr Lek. 2013 May;59(5):357–60.
• 9. Rahman R, Ju J, Shamma’s J, Goebel S, Sundaram U. Correlation between MRCP and ERCP findings at a tertiary care hospital. W V Med J. 2010;106(5):14–9.
• 10. Soto JA, Barish MA, Yucel EK, Siegenberg D, Ferrucci JT, Chuttani R. Magnetic resonance cholangiography: Comparison with endoscopic retrograde cholangiopancreatography. Gastroenterology. 1996;110(2):589–97.
• 11. A M, AK G, DK V, S S. The Value of Magnetic Resonance Cholangio-Pancreatography (MRCP) in the Detection of Choledocholithiasis. J Clin DIAGNOSTIC Res. 2013;7(9).
• 12. Holzknecht N, Gauger J, Sackmann M, Thoeni RF, Schurig J, Holl J, et al. Breath-hold MR cholangiography with snapshot techniques: Prospective comparison with endoscopic retrograde cholangiography. Radiology. 1998;206(3):657–64.
• 13. Düşünceli E, Erden A, Erden I. [Anatomic variations of the bile ducts: MRCP findings]. Tanisal ve girisimsel radyoloji Tibbi Goruntuleme ve Girisimsel Radyoloji Dern yayin organi. 2004 Dec;10(4):296–303.
• 14. Srinivasa S, Sammour T, McEntee B, Davis N, Hill AG. Selective use of magnetic resonance cholangiopancreatography in clinical practice may miss choledocholithiasis in gallstone pancreatitis. Can J Surg. 2010 Dec;53(6):403–7.
• 15. Zidi SH, Prat F, Le Guen O, Rondeau Y, Rocher L, Fritsch J, et al. Use of magnetic resonance cholangiography in the diagnosis of choledocholithiasis: prospective comparison with a reference imaging method. Gut. 1999 Jan;44(1):118–22.
• 16. Nandalur KR, Hussain HK, Weadock WJ, Wamsteker EJ, Johnson TD, Khan AS, et al. Possible biliary disease: diagnostic performance of high-spatial-resolution isotropic 3D T2-weighted MRCP. Radiology. 2008 Dec;249(3):883–90.
• 17. Kats J, Kraai M, Dijkstra AJ, Koster K, Ter Borg F, Hazenberg HJA, et al. Magnetic resonance cholangiopancreaticography as a diagnostic tool for common bile duct stones: a comparison with ERCP and clinical follow-up. Dig Surg. 2003;20(1):32–7.
• 18. Catalano C, Pavone P, Laghi A, Panebianco V, Scipioni A, Fanelli F, et al. Pancreatic adenocarcinoma: combination of MR imaging, MR angiography and MR cholangiopancreatography for the diagnosis and assessment of resectability. Eur Radiol. 1998;8(3):428–34.
• 19. Diehl SJ, Lehmann KJ, Gaa J, Meier-Willersen HJ, Wendl K, Georgi M. [The value of magnetic resonance tomography (MRT), magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of pancreatic tumors]. Rofo. 1999 May;170(5):463–9.
• 20. Kim MJ, Mitchell DG, Ito K, Outwater EK. Biliary dilatation: differentiation of benign from malignant causes--value of adding conventional MR imaging to MR cholangiopancreatography. Radiology. 2000 Jan;214(1):173–81.
• 21. Vogl TJ, Schwarz WO, Heller M, Herzog C, Zangos S, Hintze RE, et al. Staging of Klatskin tumours (hilar cholangiocarcinomas): comparison of MR cholangiography, MR imaging, and endoscopic retrograde cholangiography. Eur Radiol. 2006 Oct;16(10):2317–25.
• 22. Adamek HE, Albert J, Weitz M, Breer H, Schilling D, Riemann JF. A prospective evaluation of magnetic resonance cholangiopancreatography in patients with suspected bile duct obstruction. Gut. 1998 Nov;43(5):680–3.
• 23. Lopez Hänninen E, Amthauer H, Hosten N, Ricke J, Böhmig M, Langrehr J, et al. Prospective evaluation of pancreatic tumors: accuracy of MR imaging with MR cholangiopancreatography and MR angiography. Radiology. 2002 Jul;224(1):34–41.
• 24. Becker CD, Grossholz M, Becker M, Mentha G, de Peyer R, Terrier F. Choledocholithiasis and bile duct stenosis: diagnostic accuracy of MR cholangiopancreatography. Radiology. 1997 Nov;205(2):523–30.
• 25. Erden A, Ormeci N, Fitoz S, Erden I, Tanju S, Genç Y. Intrabiliary rupture of hepatic hydatid cysts: diagnostic accuracy of MR cholangiopancreatography. AJR Am J Roentgenol. 2007;189(2).
• 26. Yun EJ, Choi CS, Yoon DY, Seo YL, Chang SK, Kim JS, et al. Combination of magnetic resonance cholangiopancreatography and computed tomography for preoperative diagnosis of the mirizzi syndrome. J Comput Assist Tomogr. 2009 Jul;33(4):636–40.
• 27. Kantarci M, Pirimoglu B, Karabulut N, Bayraktutan U, Ogul H, Ozturk G, et al. Non-invasive detection of biliary leaks using Gd-EOB-DTPA-enhanced MR cholangiography: Comparison with T2-weighted MR cholangiography. Eur Radiol. 2013 Oct;23(10):2713–22.
• 28. Cieszanowski A, Stadnik A, Lezak A, Maj E, Zieniewicz K, Rowinska-Berman K, et al. Detection of active bile leak with Gd-EOB-DTPA enhanced MRcholangiography: Comparison of 20?25 min delayed and 60?180 mindelayed images. Eur J Radiol. 2013;82(12):2176–82.