Magnetic resonance-cholangiopancreatography in the diagnosis of biliopancreatic diseases

doi:10.1016/S0002-9610(97)00022-6

The American Journal of Surgery

Volume 174, Issue 1, July 1997, Pages 33-38

https://doi.org/10.1016/S0002-9610(97)00022-6 Get rights and content

background

Magnetic resonance Cholangiopancreatography (MRCP) is a new, noninvasive imaging technique for the visualization of the biliary ducts with cholangiographic images similar to those obtained with endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography. No contrast medium injection is used. The aim of this study was to assess the feasibility of MRCP versus ERCP in the diagnosis of biliary tract and pancreatic diseases. patients and methods: One hundred and thirty-six patients were submitted to MRCP. They were referred to MR study according to four inclusion

criteria

(1) evidence or suspicion of choledocholithiasis, (2) benign or malignant bile ducts stenosis, (3) follow-up of patients submitted to biliaryenteric anastomosis, and (4) chronic pancreatitis with Wirsung duct dilatation. The MRCP was performed with a 0.5T superconducting magnet (Philips Gyroscan T5). When neoplastic disease was detected, additional images on axial planes were acquired. MRCP allowed images of diagnostic value to be obtained in all the cases.

results

In choledocholithiasis, MRCP showed 91.6% sensitivity, 100% specificity, and overall diagnostic accuracy 96.8%. Of 48 patients with stenotic lesions, 16 were correctly characterized as benign and 30 as malignant. Two cases of focal chronic pancreatitis were misdiagnosed as pancreatic head carcinoma. In the patients submitted to biliary-enteric anastomosis, MCRP was able to detect the dilatation of the intrahepatic ducts, the stenosis, and associated stones in all 8 positive cases. In the remaining 7 patients with mild signs of cholangitis, MCRP showed irregular aspects of the biliary tree in the main ducts. In the 11 patients with chronic pancreatitis, MCRP was able to depict the dilated Wirsung duct and the stenotic tract, although the fine details of the secondary ducts were not evaluated due to the low spatial resolution as compared with conventional films.

conclusions

MRCP can be considered a technique able to completely replace diagnostic ERCP. Further studies are necessary for a better evaluation of the potential advantages and disadvantages

References (17)

HamiltonI et al.
Acute pancre-atitis following endoscopic retrograde cholangiopancreatography
Clin Radiol.
(1983)
BusetM et al.
Complications tardive de l'endoscopie diagnostique et operatoire des voies bilio-pancreatique
Acta Gastroenterol Bel.
(1991)
HartR et al.
Complications of diagnostic gastrointestinal endoscopy
Endoscopy
(1990)
KullmanE et al.
Endoscopic retrograde cholangiopancreatography (ERCP) in patients with jaundice and suspected biliary obstruction
Acta Chir Scand.
(1984)
GuibaudL et al.
Bile duct obstruction and choledocholithiasis: diagnosis with MR cholangiography
Radiology.
(1995)
GuibaudL et al.
Diagnosis of choledocholithiasis: value of MR cholangiography
Am J Radiol.
(1994)
MacaulaySE et al.
Evaluation of a nonbreath-hold MR cholangiography technique
Radiology.
(1995)
MorimotoK et al.
Biliary obstruction: evaluation with three-dimensional MR cholangiography
Radiology.
(1992)

There are more references available in the full text version of this article.

Cited by (119)

Current advances in the management of chronic pancreatitis
2021, Disease-a-Month
Citation Excerpt :
On laboratory testing, elevated alkaline phosphate is commonly seen in these patients.67 Multislice CT scan, MRI, and MRCP imaging techniques shown to provide adequate imaging of pancreaticobiliary system.74,75 Management of bile duct stricture depends on the patient's presentation and morphological changes in the pancreas.
Chronic pancreatitis is characterized by irreversible destruction of pancreatic parenchyma and its ductal system resulting from longstanding inflammation, leading to fibrosis and scarring due to genetic, environmental, and other risk factors. The diagnosis of chronic pancreatitis is made based on a combination of clinical features and characteristic findings on computed tomography or magnetic resonance imaging. Abdominal pain is the most common symptom of chronic pancreatitis. The main aim of treatment is to relieve symptoms, prevent disease progression, and manage complications related to chronic pancreatitis. Patients who do not respond to medical treatment or not a candidate for surgical treatment are usually managed with endoscopic therapies. Endoscopic therapies help with symptoms such as abdominal pain and jaundice by decompression of pancreatic and biliary ducts. This review summarizes the risk factors, pathophysiology, diagnostic evaluation, endoscopic treatment of chronic pancreatitis, and complications. We have also reviewed recent advances in endoscopic retrograde cholangiopancreatography and endoscopic ultrasound-guided therapies for pancreatic duct obstruction due to stones, strictures, pancreatic divisum, and biliary strictures.
ACR Appropriateness Criteria <sup>®</sup> Jaundice
2019, Journal of the American College of Radiology
Jaundice is the end result of myriad causes, which makes the role of imaging in this setting particularly challenging. In the United States, the most common causes of all types of jaundice fall into four categories including hepatitis, alcoholic liver disease, blockage of the common bile duct by a gallstone or tumor, and toxic reaction to a drug or medicinal herb. Clinically, differentiating between the various potential etiologies of jaundice requires a detailed history, targeted physical examination, and pertinent laboratory studies, the results of which allow the physician to categorize the type of jaundice into mechanical or nonmechanical causes. Imaging modalities used to evaluate the jaundiced patient (all etiologies) include abdominal ultrasound (US), CT, MR cholangiopancreatography, endoscopic retrograde cholangiopancreatography and endoscopic US.
The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Success and safety of endoscopic retrograde cholangiopancreatography in children
2017, Journal of Pediatric Surgery
Despite its diagnostic and therapeutic utility, endoscopic retrograde cholangiopancreatography (ERCP) is underutilized in children.
Patients younger than 18 years undergoing ERCP from 2000 to 2014 at a children's hospital were identified. Patient characteristics and outcomes were evaluated.
Overall, 215 ERCPs (78% therapeutic) were performed in 184 patients. Our cohort was 67% female, with a median age (IQR) of 14 (8) years. Common indications were choledocholithiasis, pancreatitis, sclerosing cholangitis, and postoperative complication. ERCP was performed with an adult duodenoscope in 96% of cases and with a pediatric duodenoscope in the remainder. Patients requiring a pediatric scope ranged in weight from 4.3 to 22.8 kg, with ages from 2 months to 6 years. Cannulation was successful in 97% of cases. Findings included bile duct (BD) stones, BD dilatation, sclerosing cholangitis, BD stricture, pancreatic duct (PD) disruption, choledochal cyst, pancreas divisum, and BD leak. The most common therapeutic techniques were sphincterotomy, stone extraction, and stent. Complication rate was overall 10% with no deaths. On multivariate analysis, PD cannulation was associated with pancreatitis (OR 3.48), while age < 4 years (10.7), male gender (12.8), and precut sphincterotomy (31.3) were associated with hemorrhage (all p < 0.05).
ERCP can be performed successfully and safely in children with complication rates comparable to those in adults. The type of cannulation and patient age are independent risk factors for complications.
Treatment study—IV.
Magnetic resonance cholangiopancreatography still plays a role in the preoperative evaluation of choledocholithiasis and biliary pathology
2016, Journal of the American College of Surgeons
Investigation of jaundice
2015, Medicine (United Kingdom)
Jaundice is a clinical sign that reflects accumulation of bilirubin in blood. It can result from increased bilirubin production, inability of the liver to conjugate bilirubin or failure to excrete bilirubin into the biliary tree. Appropriate investigation of jaundice starts with a history of associated symptoms, and risk factors for liver disease. Clinical examination should look for stigmata of chronic liver disease and signs of specific liver diseases. Initial blood tests should assess liver injury and synthetic function. A combination of urinalysis and the pattern of abnormal liver function tests can indicate whether the jaundice is likely to be hepatitic or cholestatic, and guide further investigations. This review will describe bilirubin metabolism, the causes of jaundice, and the appropriate investigation of jaundice.
Use of magnetic resonance cholangiopancreatography in clinical practice: Not as good as we once thought
2015, Journal of the American College of Surgeons
Magnetic resonance cholangiopancreatography (MRCP) is believed to be a useful tool to evaluate the biliary tree and pancreas for stones, tumors, or injuries to the ductile system. The purpose of this study was to compare the accuracy of MRCP to the gold standard, endoscopic retrograde cholangiopancreatography (ERCP), in our institution.
We performed a retrospective review of all MRCP followed by ERCP (follow-on ERCP) at a single institution over a 6-year period. Exam findings from MRCP were compared with findings on the follow-on ERCP and compared. Studies were grouped into 2 main classifications: tests being performed for patients with suspected choledocholithiasis (stone disease) and tests being performed for concerns of malignant strictures or duct injuries (non-stone disease).
A total of 81 patients had MRCPs and follow-on ERCPs in this time period. Thirty-six patients had positive findings on MRCP and ERCP for stones in the common duct system, and 14 patients had positive findings on MRCP and subsequent ERCP for masses and strictures of the common duct. Three patients had positive MRCP and ERCP findings for pancreatic duct abnormalities. The specificity and positive predictive value of MRCP were 94% and 98%, respectively. However, 13 of 28 patients had lesions identified on ERCP after a normal MRCP. The sensitivity and negative predictive value were 80% and 54%, respectively.
Magnetic resonance cholangiopancreatography was not useful in the management algorithm of either stone or non-stone disease of the biliary tree or pancreas. It should be abandoned as a diagnostic tool for work-up of biliary duct pathology.

View all citing articles on Scopus

View full text

Scientific paperMagnetic resonance-cholangiopancreatography in the diagnosis of biliopancreatic diseases

background

criteria

results

conclusions

Clin Radiol.

Complications tardive de l'endoscopie diagnostique et operatoire des voies bilio-pancreatique

Acta Gastroenterol Bel.

Complications of diagnostic gastrointestinal endoscopy

Endoscopy

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with jaundice and suspected biliary obstruction

Acta Chir Scand.

Bile duct obstruction and choledocholithiasis: diagnosis with MR cholangiography

Radiology.

Diagnosis of choledocholithiasis: value of MR cholangiography

Am J Radiol.

Evaluation of a nonbreath-hold MR cholangiography technique

Radiology.

Biliary obstruction: evaluation with three-dimensional MR cholangiography

Radiology.

Scientific paper
Magnetic resonance-cholangiopancreatography in the diagnosis of biliopancreatic diseases