Role of MRCP to determine the etiological spectrum, level and degree of biliary obstruction in obstructive jaundice

Abstract

Context: Obstructive jaundice as a result of hepatocellular disease many a times is indistinguishable from jaundice due to extrahepatic biliary obstruction based on just clinical and biochemical examinations. It is one of the most frequent and grave form of hepatobiliary disease which may lead to complications like ascending cholangitis, malabsorption and hepatorenal syndrome, thus demanding urgent surgical intervention. Thus not only early diagnosis but also accurate identification of level and cause of obstruction is crucial in managing these patients. Aims: The aim of this study is to evaluate the role of MRCP in the determination of the etiological spectrum, to evaluate level and degree of biliary obstruction in cases of obstructive jaundice, and to correlate MRCP findings with surgical/histopathology/ERCP findings where possible. Methods and Material: It is an observational study done after the Institutional Ethics Committee (I.E.C.)- 2 approval. (IEC no: IEC/HMPCMCE/122/Faculty/8/186/20) Outdoor and indoor patients referred to radiodiagnosis department of Shree Krishna Hospital, Karamsad, for MRCP with clinical and laboratory parameters suggesting obstructive jaundice were included in the study. Patients less than 10 years of age, those with contraindications to MRI and patients with clinico-laboratory evidence of perihepatic/hepatic jaundice were excluded. Methodology: A total of 50 patients were included after taking an informed consent from each patient. Demographic data, clinical details were recorded and collated along with MRI findings. Descriptive statistics was used to explore MRI findings and findings were correlated with surgical/histopathology/ERCP findings whichever applicable. The MRI scan was performed with 5 mm thick axial T1W, T2W and STIR, 5 mm thick coronal T1W, T2W and STIR TRUFIS, Thin coronal T2 FS, Thick coronal T2 FS, T2W coronal respiratory trigger sequences, 3-5 mm thick T2 weighted Haste and 3D sequence. Statistical Analysis Used: Analysis was performed using STATA (14.2). Descriptive statistics was used of study population. Sensitivity and specificity value was used to compare the modality and individually calculated for various causative factors of jaundice. Results: Of the 50 patients, 9 had CBD stones, it is observed that MRCP has sensitivity and specificity of 100% and 100%, respectively, in detecting Bile duct stones, whereas sensitivity and specificity of ERCP was 87.5% each. About 11 patients had CBD strictures, which were seen as narrowing of CBD with upstream dilatation. It was observed in our study that the sensitivity of MRCP was 93% and specificity was 95% in detecting CBD strictures while ERCP had 100% sensitivity and specificity. About 12 patients had CBD tumor for sensitivity and specificity of MRCP and ERCP was 100%. Out of 50 patients, 36% had gall bladder stones in whom MRCP sensitivity and specificity wa...

Insights to obstructive jaundice: comprehensive analysis and machine learning-based diagnostics in over 5000 individuals

“…Chinese center over a period of 14 years. Smaller retrospective cohort studies conducted across Europe, Australia, Central Asia and South Asia have provided valuable insights into obstructive jaundice [16][17][18][19][20][21][22]. Notably, Garcea et al's retrospective analysis of over 1000 cases in the United Kingdom found similar disease patterns to ours, with CBD stones and pancreatic ductal adenocarcinoma as primary benign and malignant etiologies, respectively [19].…”

Comparison of diagnostic usefulness of magnetic resonance cholangiopancreatography (MRCP) with endoscopic retrograde cholangiopancreatography (ERCP) in evaluation of patients with obstructive jaundice.

“…Expert gastroenterologist and radiologist along with a trained team is needed for the ERCP and procedure is done under sedation or general anesthesia. 5,6 Despite its usefulness, the procedure of ERCP is however related to some unwanted complication which includes sepsis, bleeding, bile leakage, pancreatitis and even a reported rate of mortality up to 1%. 7 A procedure called magnetic resonance cholangiopancreatography (MRCP) introduced in 1991 is now under frequent use for diagnostic purposes in the pathologies related to pancreatic duct and hepatobiliary diseases.…”