Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Role of Magnetic Resonance Cholangiopancreatography in Evaluation of Choledocholithiasis in Patients with Suspected Cholecystitis

담낭염 의심 환자들에서 담도결석 진단을 위한 자기공명 담췌관 조영술의 역할

  • You, Myung-Won (Department of Radiology, Nowon Eulji Medical Center, Eulji University) ;
  • Jung, Yoon Young (Department of Radiology, Nowon Eulji Medical Center, Eulji University) ;
  • Shin, Ji-Yeon (Department of Preventive Medicine, School of Medicine, Eulji University)
  • 유명원 (을지대학교 을지병원 영상의학과) ;
  • 정윤영 (을지대학교 을지병원 영상의학과) ;
  • 신지연 (을지대학교 의과대학 예방의학교실)
  • Received : 2017.05.12
  • Accepted : 2017.09.13
  • Published : 2018.03.01
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Abstract

Purpose: To determine the role of magnetic resonance cholangiopancreatography (MRCP) in evaluation of choledocholithiasis in patients with suspected cholecystitis. Materials and Methods: A total of 78 patients (mean age: $66.06{\pm}15.63years$; range: 21-94 years, Male:Female = 31:47) who had experienced symptoms of cholecystitis and who underwent computed tomography (CT), MRCP, and endoscopic retrograde cholangiopancreatography from January 2013 to February 2015 were included in this study. Two reviewers independently interpreted CT and MRCP images to determine the presence or absence of choledocholithiasis and cholelithiasis. Diagnostic performance (sensitivity, specificity, positive predictive value, negative predictive value, and accuracy) was compared between CT and MRCP. Interobserver agreement was also evaluated. Results: Forty-three patients underwent cholecystectomy. The accuracy of CT and MRCP for detection of gallbladder stones showed no significant difference. The sensitivity and accuracy of MRCP for detection of extrahepatic duct stones were superior to those of CT for both reviewers (reviewer 1: MRCP: sensitivity, 73.3%; accuracy, 76.9%; CT: sensitivity, 50%, accuracy 59%; p = 0.01; reviewer 2: MRCP: sensitivity, 75%; accuracy, 73.1%; CT: sensitivity, 50%; accuracy, 56.4%; p = 0.018). The interobserver agreement was consistent for both CT (k-value: 0.738) and MRCP (k-value: 0.701). Conclusion: MRCP showed superior diagnostic performance for the detection of choledocholithiasis with reliable interobserver agreement. Considering the lack of radiation and contrast enhancement, MRCP would be an appropriate first-line modality in evaluation of common bile duct stones in patients with suspected cholecystitis.

목적: 담낭염이 의심되는 환자들에서 자기공명 담췌관 조영술(magnetic resonance cholangiopancreatography; 이하 MRCP)의 역할을 알아보고자 하였다. 대상과 방법: 2013년 1월부터 2015년 2월 사이에 담낭염 증상으로 computed tomography (이하 CT), MRCP와 역행성 담췌관 조영술(endoscopic retrograde cholangiopancreatography)을 시행받은 총 78명의 환자들이 포함되었다(평균 나이 $66.06{\pm}15.63$세; 나이 범위 21~94세, 남:여 = 31:47). 두 명의 검토자가 독립적으로 담도결석과 담낭결석 여부에 대해 CT와 MRCP 영상을 분석하였고, CT와 MRCP의 진단능(민감도, 특이도, 양성예측도, 음성예측도, 정확도)을 비교하였다. 관찰자 간 일치도는 k 계수를 이용해 측정하였다. 결과: 43명의 환자가 담낭절제술을 시행받았다. 담낭결석에 대한 정확도는 CT와 MRCP 사이에 유의한 차이가 없었다. 두 명의 검토자 모두에서 담도 결석에 대한 민감도와 정확도는 MRCP가 CT보다 우월하였다(검토자 1: MRCP 민감도 73.3%, 정확도 76.9%; CT 민감도 50%, 정확도 59%; p = 0.01, 검토자 2: MRCP 민감도 75%, 정확도 73.1%; CT 민감도 50%, 정확도 56.4%; p = 0.018). 관찰자 간 일치도는 CT (k 계수: 0.738)와 MRCP (k 계수: 0.701)가 일관되게 나타났다. 결론: MRCP는 담도결석을 진단하는 데 있어 우월한 진단능을 보였고 관찰자 간 일치도 또한 신뢰할 만하였다. 방사선 조사와 조영제가 없다는 것을 고려한다면, MRCP가 담낭염 의심 환자의 담도결석을 진단하는 첫 번째 검사로 적합하겠다.

Keywords

Acknowledgement

Supported by : National Research Foundation of Korea (NRF)

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