Download PDF
Endoscopy 2002; 34(12): 984-990
DOI: 10.1055/s-2002-35830
Original Article
© Georg Thieme Verlag Stuttgart · New York

Three-Dimensional Magnetic Resonance Cholangiopancreatography with Respiratory Triggering in the Diagnosis of Primary Sclerosing Cholangitis: Comparison with Endoscopic Retrograde Cholangiography

H.  J.  Textor 1 , S.  Flacke 1 , D.  Pauleit 1 , E.  Keller 2 , M.  Neubrand 2 , B.  Terjung 2 , J.  Gieseke 3 , C.  Scheurlen 2 , T.  Sauerbruch 2 , H.  H.  Schild 1
  • 1 Dept. of Radiology, Bonn University Hospital, Bonn, Germany
  • 2 Dept. of General Internal Medicine, Bonn University Hospital, Bonn, Germany
  • 3 Philips Medical Systems, Best, The Netherlands
Further Information

Publication History

Submitted: 7 August 2001

Accepted after Revision: 25 July 2002

Publication Date:
02 December 2002 (online)

Also available at
    Permissions and Reprints

Background and Study Aims: The purpose of this study was to evaluate the accuracy of respiratory-triggered three-dimensional magnetic resonance cholangiopancreatography (3D-MRCP) for the detection of primary sclerosing cholangitis (PSC) and to compare the specific findings of magnetic resonance cholangiography and endoscopic retrograde cholangiography in patients with PSC.
Patients and Methods: The MRCP findings were evaluated in 150 patients with clinical symptoms (progressive fatigue, pruritus followed by icterus) and/or elevated values for alkaline phosphatase and serum aspartate transaminase, and occasionally an elevated serum concentration of bilirubin as a sign of cholestasis, who were consecutively referred for magnetic resonance imaging. Two observers independently classified bile duct abnormalities and established the MRCP diagnosis in a consensus reading. The results of MRCP were compared with the definitive diagnosis, which was based on the clinical history and laboratory and histological data, as well as on endoscopic retrograde cholangio-pancreatography (ERCP) findings. In a second step, the observers compared the delineation of the biliary system and morphological findings using MRCP and ERCP in patients with confirmed PSC.
Results: Diagnostic examinations were obtained in 146 of the 150 MRCPs (97 %). The diagnosis of PSC was confirmed by clinical data and ERCP in 34 of these 150 patients (23 %). The sensitivity and specificity of MRCP for diagnosing PSC were 88 % (29 of 33) and 99 % (108 of 109), respectively. MRCP and ERCP yielded similar scores for the delineation of the biliary system (P = 0.2) in patients with PSC. However, different bile duct abnormalities leading to the diagnosis of PSC were depicted by MRCP and ERCP; more bile duct stenoses and pruning were seen with ERCP and more skip dilatation with MRCP (P < 10-4).
Conclusion: In patients with PSC, MRCP is a highly sensitive method and its diagnostic accuracy is comparable to that of ERCP.

References

  • 1 Porayko M K, LaRusso N F, Wiesner R H. Primary sclerosing cholangitis: a progressive disease?.  Semin Liver Dis. 1991;  11 18-25
    PubMedGoogle Scholar
  • 2 Lee J G, Schutz S M, England R E. et al . Endoscopic therapy of sclerosing cholangitis.  Hepatology. 1995;  21 661-667
    CrossrefPubMedGoogle Scholar
  • 3 Harrison P M. Diagnosis of primary sclerosing cholangitis.  J Hepatobiliary Pancreat Surg. 1999;  6 356-360
    CrossrefPubMedGoogle Scholar
  • 4 Okolicsanyi L, Fabris L, Viaggi S. et al . Primary sclerosing cholangitis: clinical presentation, natural history and prognostic variables: an Italian multicentre study. The Italian PSC Study Group.  Eur J Gastroenterol Hepatol. 1996;  8 685-691
    PubMedGoogle Scholar
  • 5 LaRusso N F, Wiesner R H, Ludwig J, MacCarty R L. Current concepts: primary sclerosing cholangitis.  N Engl J Med. 1984;  310 899-903
    PubMedGoogle Scholar
  • 6 MacCarty R L, LaRusso N F, Wiesner R H, Ludwig J. Primary sclerosing cholangitis: findings on cholangiography and pancreatography.  Radiology. 1983;  149 39-44
    PubMedGoogle Scholar
  • 7 Craig D A, MacCarty R L, Wiesner R H. et al . Primary sclerosing cholangitis: value of cholangiography in determining the prognosis.  Am J Roentgenol. 1991;  157 959-964
    PubMedGoogle Scholar
  • 8 Loperfido S, Angelini G, Benedetti G. et al . Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study.  Gastrointest Endosc. 1998;  48 1-10
    CrossrefPubMedGoogle Scholar
  • 9 Pedersen J H, Christensen R F, Juul N, Burcharth F. Comparison of ultrasonography and transhepatic cholangiography in the evaluation of obstructive jaundice.  RöFo Fortschr Geb Röntgenstr Nuklearmed. 1985;  143 41-43
    PubMedGoogle Scholar
  • 10 Testoni P A, Caporuscio S, Bagnolo F, Lella F. Twenty-four-hour serum amylase predicting pancreatic reaction after endoscopic sphincterotomy.  Endoscopy. 1999;  31 131-136
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Oberholzer K, Lohse A W, Mildenberger P. et al . Diagnosis of primary sclerosing cholangitis: prospective comparison of MR cholangiography with endoscopic retrograde cholangiography.  Röfo Fortschr Geb Röntgenstr Neuen Bildgeb Verfahr. 1998;  169 622-626
    PubMedGoogle Scholar
  • 12 Ito K, Mitchell D G, Outwater E K, Blasbalg R. Primary sclerosing cholangitis: MR imaging features.  Am J Roentgenol. 1999;  172 1527-1533
    PubMedGoogle Scholar
  • 13 Ernst O, Asselah T, Sergent G. et al . MR cholangiography in primary sclerosing cholangitis.  Am J Roentgenol. 1998;  171 1027-1030
    PubMedGoogle Scholar
  • 14 Fulcher A S, Turner M A, Franklin K J. et al . Primary sclerosing cholangitis: evaluation with MR cholangiography - a case-control study.  Radiology. 2000;  215 71-80
    CrossrefPubMedGoogle Scholar
  • 15 Angulo P, Pearce D H, Johnson C D. et al . Magnetic resonance cholangiography in patients with biliary disease: its role in primary sclerosing cholangitis.  J Hepatol. 2000;  33 520-527
    CrossrefPubMedGoogle Scholar
  • 16 Haider M A, Bret P M. The role of magnetic resonance cholangiography in primary sclerosing cholangitis.  J Hepatol. 2000;  33 659-660
    CrossrefPubMedGoogle Scholar
  • 17 Vitellas K M, Keogan M T, Freed K S. et al . Radiologic manifestations of sclerosing cholangitis with emphasis on MR cholangiopancreatography.  Radiographics. 2000;  20 959-975
    CrossrefPubMedGoogle Scholar
  • 18 Hintze R E, Adler A, Veltzke W. et al . Clinical significance of magnetic resonance cholangiopancreatography (MRCP) compared to endoscopic retrograde cholangiopancreatography (ERCP).  Endoscopy. 1997;  29 182-187
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Soto J A, Barish M A, Yucel E K, Ferrucci J T. MR cholangiopancreatography: findings on 3D fast spin-echo imaging.  Am J Roentgenol. 1995;  165 1397-1401
    PubMedGoogle Scholar
  • 20 Terada T, Nakanuma Y. Intrahepatic cholangiographic appearance simulating primary sclerosing cholangitis in several hepatobiliary diseases: a postmortem cholangiographic and histopathological study in 154 livers at autopsy.  Hepatology. 1995;  22 75-81
    CrossrefPubMedGoogle Scholar
  • 21 Hart R, Classen M. Complications of diagnostic gastrointestinal endoscopy.  Endoscopy. 1990;  22 229-233
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Soto J A, Yucel E K, Barish M A. et al . MR cholangiopancreatography after unsuccessful or incomplete ERCP.  Radiology. 1996;  199 91-98
    PubMedGoogle Scholar
  • 23 Adamek H E, Weitz M, Breer H. et al . Value of magnetic resonance cholangiopancreatography (MRCP) after unsuccessful endoscopic retrograde cholangiopancreatography (ERCP).  Endoscopy. 1997;  29 741-744
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Fulcher A S, Turner M A, Capps G W, Zfass A M, Baker K M. Half-Fourier RARE MR cholangiopancreatography: experience in 300 subjects.  Radiology. 1998;  207 21-32
    CrossrefPubMedGoogle Scholar
  • 25 Regan F, Schaefer D C, Smith D P. et al . The diagnostic utility of HASTE MRI in the evaluation of acute cholecystitis: half-Fourier acquisition single-shot turbo SE.  J Comput Assist Tomogr. 1998;  22 638-642
    CrossrefPubMedGoogle Scholar
  • 26 Hirohashi S, Hirohashi R, Uchida H. et al . Pancreatitis: evaluation with MR cholangiopancreatography in children.  Radiology. 1997;  203 411-415
    PubMedGoogle Scholar
  • 27 Ichikawa T, Nitatori T, Hachiya J, Mizutani Y. Breath-held MR cholangiopancreatography with half-averaged single shot hybrid rapid acquisition with relaxation enhancement sequence: comparison of fast GRE and SE sequences.  J Comput Assist Tomogr. 1996;  20 798-802
    CrossrefPubMedGoogle Scholar
  • 28 Miyazaki T, Yamashita Y, Tsuchigame T. et al . MR cholangiopancreatography using HASTE (half-Fourier acquisition single-shot turbo spin-echo) sequences.  Am J Roentgenol. 1996;  166 1297-1303
    PubMedGoogle Scholar
  • 29 Beuers U, Spengler U, Sackmann M. et al . Deterioration of cholestasis after endoscopic retrograde cholangiography in advanced primary sclerosing cholangitis.  J Hepatol. 1992;  15 140-143
    CrossrefPubMedGoogle Scholar
  • 30 Baluyut A R, Sherman S, Lehman G A. et al . Impact of endoscopic therapy on the survival of patients with primary sclerosing cholangitis.  Gastrointest Endosc. 2001;  53 308-312
    CrossrefPubMedGoogle Scholar
  • 31 Angulo P, Lindor K D. Primary sclerosing cholangitis.  Hepatology. 1999;  30 325-332
    CrossrefPubMedGoogle Scholar
  • 32 Lee S G, Lee Y J, Park K M. et al . One hundred and eleven liver resections for hilar bile duct cancer.  J Hepatobiliary Pancreat Surg. 2000;  7 135-141
    CrossrefPubMedGoogle Scholar
  • 33 Revelon G, Rashid A, Kawamoto S, Bluemke D A. Primary sclerosing cholangitis: MR imaging findings with pathologic correlation.  Am J Roentgenol. 1999;  173 1037-1042
    PubMedGoogle Scholar

H. J. Textor, M.D.

Bonn University Hospital

Sigmund Freud Strasse 25 · 53127 Bonn · Germany ·

Fax: + 49-228-287 5598

Email: textor@uni-bonn.de

      >