No abstract

Obstruction is one of the most common problems in biliary tree pathology, combined magnetic resonance imaging (MRI) and Magnetic Resonance Cholangiopancreatography (MRCP) regarded as accurate imaging modalities in diagnosis the cause of obstruction and treatment planning due to information obtain from MRCP about biliary and pancreatic ducts, information obtains from MRI cross sections about surrounding parenchyma. This study was aimed to investigate the efficacy of combined MRCP and MRI in differentiation between benign and malignant causes of biliary dilatation and their sensitivity in detection specific cause of biliary dilatation. This study involved 72 patients and conducted in Al-Diwaniyah Teaching Hospital, Iraq during a period from February 2013 to June 2017, the diagnosis of biliary dilatation was done by abdominal ultrasound to all patients followed by MRCP/MRI, the results of MRCP/MRI was compared with final diagnoses done by endoscopic retrograde cholangiopancreatography (ERCP), surgical, histopathological and laboratory results. The results revealed that a strong correlation between MRCP/MRI and other gold standard tools in differentiation between benign and malignant causes of obstruction. Sensitivity, specificity, and accuracy of MRCP in differentiation between malignant and benign causes of biliary dilatation were 98.4%, 100% & 99.7% respectively. There was a strong correlation (0.990) between MRCP/MRI & final diagnosis to determine the specific cause of obstruction, correct diagnosis the cause of obstruction in 68 patients out of 72 with a sensitivity of 94%. This study concluded that combined MRCP/MRI plays an important role in differentiation benign & malignant causes of biliary obstruction and in differentiation the specific cause of obstruction. Keywords: MRI; MRCP; Biliary obstruction; ERCP

Computed tomography is commonly used for the initial diagnosis of a tumour to provide information about the stage of cancer & to assess whether the disease is responding to treatment. Leukemia & solid tumour may have developed as a result of exposure to a low dose of diagnostic ionizing radiation so another primary tumour may develop as a result of radiation exposure. We used information in the patient sheet to measure patient effective radiation dose(E) in millisievert (mSv) & calculate cumulative dose by summation of dose over three years, estimated life attributed risk & mortality rate. The results of the current study revealed that from 50 patients 37 (74%) of them were female & 13 (26%) of them were male, age range 23- 80yr, breast cancer was the commonest cause of malignancy follow by lung cancer. Cumulative dose in mSv/yr rang 12-80 mSv, about 43(86%) of our patients exposed to more than 20mSv /yr & 7(14%) of them expose to 20 & less than 20 per year. Collective dose in three years’ range was 35-250 mSv mean 97 ± 37 Estimated radiological effective dose was more than 100 mSv in 22 (44%) per three years & 28(56%) of them had less than 100mSv. Life attributed risk for incidence of cancers was 1:285 -1:40 & mortality rate 0.21%-1.5%. A high percentage of patient 86% with cancer receive high radiation dose annually from CT scan more than considerable safe radiation dose for a worker in this field and 44% of our patient expose to cumulative dose more than 100 mSv per three which is also excess allowed dose for the radiological worker.