ArticlesPancreatic cancer detection with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography: a prospective controlled study
Introduction
The diagnosis of pancreatic cancer and chronic pancreatitis is notoriously problematic, in that both diseases may have unspecific clinical symptoms. Even on the basis of imaging criteria (percutaneous or endoscopic ultrasound, endoscopic retrograde cholangio-pancreatography, and computed tomography) and molecular techniques chronic pancreatitis sometimes remains difficult to distinguish from pancreatic cancer.1, 2 The therapeutic advantages of an early diagnosis are obvious and indicate the need for a noninvasive, highly sensitive, and specific method—one that can discriminate between benign and neoplastic pancreatic lesions.
Magnetic resonance cholangiopancreatography (MRCP) is an abdominal magnetic resonance imaging (MRI) procedure, in which the biliary and pancreatic ducts can be visualised without contrast material.3, 4, 5 Several groups have reported favourable results with MRCP to evaluate a variety of common-bileduct diseases.6, 7 However, no prospective controlled studies have used MRCP in an attempt to distinguish chronic pancreatitis from pancreatic carcinoma.
The aim of this current study is to prospectively assess the diagnostic value of MRCP to diagnose pancreatic cancer compared with histopathological evidence or a follow-up examination of at least 12 months.
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Patients
Patients strongly suspected of having pancreatic tumours were included in this study. A strong suspicion was defined as a combination of: clinical history (suspected or previously known chronic pancreatitis, one or more attacks of acute pancreatitis); specific symptoms (epigastric or back pain, jaundice, fever, early satiety, weight loss); laboratory results (carbohydrate antigen 19-9 or carcinoembryonic antigen, serum bilirubin, alkaline phosphatase, gammaglutamyl transpeptidase); ultrasound
Results
13 of 124 (10%) patients had normal pancreatic and common bile ducts (table 1). The results of ERCP and MRCP image interpretations agreed in 12 (92%) patients.
37 patients had pancreatic carcinoma. 28 masses were located in the pancreatic head, five in the pancreatic body, and four in the tail. By the use of MRCP, the biliary tract, main pancreatic duct, as well as the tumour were completely shown in 31 (84%) patients (figure 1). The correct diagnosis could be made in only 26 (70%) cases by ERCP
Discussion
ERCP is the current standard of reference for diagnostic imaging of biliary-pancreatic diseases. However, ERCP has several drawbacks—notably, the risk of many complications, the most important being pancreatitis.9, 10 With advances in MRI the diagnostic capabilities of ERCP are now challenged by MRCP. The foremost advantage of MRCP is that it avoids any possibility of complication, in that it does not require an endoscopy, contrast material, or radiation of any kind.
The value and accuracy of
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