Abstract
BACKGROUND:
The validation of the non-invasive radiological tools to replace invasive procedures like Endoscopic retrograde cholangiopancreatography (ERCP)for diagnosis of biliary obstructive disease become essential in modern medical practice. Magnetic resonance cholangiopancreatography (MRCP) is best alternative for ERCP regarding diagnostic aspects.
AIM OF STUDY:
To assess the diagnostic accuracy of MRCP and transabdominal US in identifying the cause of biliary dilatation in correlation with Endoscopic retrograde cholangiopancreatography as the gold standard.
METHODS:
A prospective cross sectional analytic study that involved 64 patients with obstructive jaundice. Abdominal US and MRCP were performed and the cause of obstruction were recorded and correlated with a subsequent ERCP results which were considered as the gold standard. Accuracy, sensitivity, specificity, positive and negative predictive values and P value were calculated for each test.
RESULTS:
Choledocholithiasis was the commonest cause of biliary obstruction (45%). The detection rate for MRCP was 96.6% and for ultrasound was 41.4% regarding CBD stones. The diagnostic performance of MRCP for malignant pathologies was (91.7%) sensitivity,100% specificity, 91.7% accuracy with significant level for detection (P value <0.001).While trans-abdominal ultrasound had lower diagnostic parameters for malignancy detection with 75% sensitivity, 66.7% specifity, 41.6% accuracy and P value (0.228).
CONCLUSION:
MRCP is a non-invasive technique that can detect level and cause of biliary obstruction with high diagnostic performance especially in choledocolithiasis and malignancies. MRCP can replace the invasive ERCP as a diagnostic tool in most cases. Also if no cause was identified in MRCP, ERCP can be avoided in most cases
10. Munir K, Bari V, Yaqoob J, Khan DB, Usman MU. The role of magnetic resonance cholangiopancreatography (MRCP) in obstructive jaundice. JPMA The Journal of the Pakistan Medical Association. 2004;54:128-32.
11. Bhatt C, Shah P, Prajapati H, Modi J. Comparison of diagnostic accuracy between USG and MRCP in biliary and pancreatic pathology. Indian Journal of Radiology and Imaging. 2005;15:177-81. https://dx.doi.org/10.4103/0971-3026.28796
12. Vazquez-Sequeiros E, Gonzalez-Panizo Tamargo F, Boixeda-Miquel D, Milicua JM. Diagnostic accuracy and therapeutic impact of endoscopic ultrasonography in patients with intermediate suspicion of choledocholithiasis and absence of findings in magnetic resonance cholangiography. Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva. 2011;103:464-71. https://dx.doi.org/10.4321/s1130-01082011000900005
13. Khopde PA, Kelkar A, Joshi P, Bandgar A, Mahajan M. Pancreatico-biliary pathologies: correlation of USG and MRCP. 2019. 2019;6:6. https://dx.doi.org/10.18203/2349-2902.isj20192969.
14. Singh A, Mann HS, Thukral CL, Singh NR. Diagnostic Accuracy of MRCP as Compared to Ultrasound/CT in Patients with Obstructive Jaundice. Journal of clinical and diagnostic research : JCDR. 2014;8:103-7. https://dx.doi.org/10.7860/JCDR/2014/8149.4120
15. Kushwah A, Jain S, Agarwal R, Tomar SP. Biliary tract obstructive diseases: a comparative evaluation by ultrasonography and magnetic resonance cholangiopancreatography (magnetic resonance imaging). Int J Sci Study. 2015;3:149-53.
16. Diwanji N, Dibbad RB, Sastri M, Desai E. The study of role of magnetic resonance cholangio-pancreatography (MRCP) in pancreato-biliary disorders. Int J Med Sci Public Health. 2016;5:2635-40. http://dx.doi.org/10.5455/ijmsph.2016.14072016578.
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