ISSN: 1300-0292
İndekslendiği Dizinler: SCIENCE CITATION INDEX EXPANDED
CINAHL, Index Copernicus,
Chemical Abstracts (CA),
Excerpta Medica / EMBASE
Dil: Türkçe, İngilizce
İçerik: Orijinal Araştırma, Derleme, Editöre Mektup, Olgu Sunumu, Tıp Eğitimi, Tıbbi Kitap İncelemeleri
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ORIGINAL RESEARCH ARTICLES |
The Role Of Magnetic Resonance Cholangiopancreatography
Dr. Ahmet Mesrur HALEFOĞLU,a Dr. Sadık YILDIRIM,b Dr. Hakan KÖKSAL,bDr. Ayşe Deniz KAHRAMAN,a Dr. Ömer AVLANMIŞ,b Dr. Adil BAYKANb
aRadyoloji Kliniği, bGenel Cerrahi Kliniği, Şişli Etfal Eğitim ve Araştırma Hastanesi, İSTANBUL
Objective: The aim of this study was to determine the superiority of conventional magnetic resonance imaging (MRI) combined with magnetic resonance cholangiopancreatography (MRCP) to conventional MRI alone in the diagnosis and resectability of pancreatic adenocancers preoperatively.
Material and Methods: Between 1996 and 2004, 65 patients operated on for pancreatic adenocancer in our hospital were included in this study. Conventional MRI and MRCP examinations were performed along with other diagnostic work-ups (CT, ERCP, CA 19-9 levels etc.) in all patients. Conventional MRI and MRI combined with MRCP were compared in the diagnosis and the evaluation of the resectability of the tumor. Besides, the results were reviewed and assessed by correlation to the intraoperative evaluations and pathologic findings. All MRI and MRCP images were interpreted by two radiologists who were blinded to the operative outcome of the patients. The definitive diagnosis and resectability was based upon the evidence of laparotomic exploration and pathology. MRI and MRCP examinations were performed by using phased-array body coil by means of a 1.5 tesla superconducting magnet (GE, Signa, Wisconsin, Milwaukee, USA).
Results: The mean age of the patients was 59 ± 4 years (range 41-88 years) and the male/female ratio was 28/37. Of the 65 patients, 60 (91%) had pancreatic head adenocarcinoma, and 5 (9%) had papillary adenocarcinoma. In 10 patients with pancreatic head cancer, tumors were resectable and the resectability was reported in 8 patients by MRI and MRCP (positive predictive value 80%). Conventional MRI detected 6 patients with resectable tumors (positive predictive value 60%). Of the 50 patients in whom the tumor was non-resectable operatively, 36 were reported to be irresectable (negative predictive value 72%). Conventional MRI detected 33 patients with irresectable tumors (negative predictive value 66%), whereas in 5 papillary cancer cases, 4 were resectable and MRI with MRCP predicted this in all patients (positive predictive value 80%). In the patient who nonresectable due to portal vein invasion, MRI and MRCP predicted the tumor as resectable. Conventional MRI showed only 2 cases who had resectable tumors (positive predictive value 40%). Overall sensitivity of the MRI modality with respect to diagnosis and assessment of resectability of the pancreatic and papillary cancer was 32% and its specificity was 86%, whereas MRI combined with MRCP showed 46% sensitivity and 92% specificity.
Conclusion: The combination of MRCP and MRI when compared with conventional MRI only provides more comprehensive and valuable information regarding both the diagnosis and assessment of the resectability of pancreatic adenocarcinomas.Keywords: Bile ducts, pancreas, neoplasms, pancreatic ducts, adenocarcinomaTurkiye Klinikleri J Med Sci 2006, 26:265-271
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