The Value of Magnetic Resonance Cholangio-Pancreatography (MRCP) in the Detection of Choledocholithiasis

Mandelia, Ankur; Gupta, Arun Kumar; Verma, Devendra Kumar; Sharma, Sanjeev

doi:10.7860/jcdr/2013/6158.3365

Cited by 25 publications

(33 citation statements)

References 19 publications

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“…[6,8,9,11,13,14,[17][18][19][20][21] A recent meta-analysis of 25 studies on the detection rate of CBD stones demonstrated an estimated sensitivity of 90% and specificity of 95% for MRCP. [22] It must be noted that many studies reporting low sensitivity and/or NPV of MRCP are more than a decade old and might be outdated due to the technological advancements of MRCP in the period following their publication.…”

Section: Discussionmentioning

confidence: 99%

“…[25][26][27] The sensitivity of MRCP has also been shown to be less for small stones (<5 mm) and for stones lodged in the ampulla of Vater as can occur during biliary pancreatitis. [16,28,29] Many studies analysing the overall diagnostic accuracy of MRCP had a very limited number of participants [5][6][7][8][9]11,[13][14][15][16][17][18][19][20][21] with a range of 30 [5,8] to 315 patients. [11] Many of these studies had a variety of different types of patients and different and/or unclear definitions of a normal or negative MRCP.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7] Thus, the non-invasive nature of MRCP has attracted attention and been compared with more invasive diagnostic approaches, such as endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). [6,[8][9][10] MRCP has in some studies been shown to have a diagnostic accuracy similar to EUS and ERCP [6,7,[10][11][12] and several studies have found MRCP to be a valuable imaging modality when CDL is suspected, with relatively high negative predictive value (NPV). [7][8][9]11] In contrast, other studies found MRCP to be potentially unreliable with low NPV [13,14] and/or relatively low sensitivity.…”

Section: Introductionmentioning

confidence: 99%

“…[6,[8][9][10] MRCP has in some studies been shown to have a diagnostic accuracy similar to EUS and ERCP [6,7,[10][11][12] and several studies have found MRCP to be a valuable imaging modality when CDL is suspected, with relatively high negative predictive value (NPV). [7][8][9]11] In contrast, other studies found MRCP to be potentially unreliable with low NPV [13,14] and/or relatively low sensitivity. [5,14,15] Furthermore, many studies on the subject have been conducted on a limited number of patients.…”

Section: Introductionmentioning

confidence: 99%

“…[5,14,15] Furthermore, many studies on the subject have been conducted on a limited number of patients. [5][6][7][8][9]11,[13][14][15][16][17][18][19][20][21] Thus, the diagnostic accuracy of MRCP in clinical practise is somewhat controversial.…”

Section: Introductionmentioning

confidence: 99%

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The value of magnetic resonance cholangiopancreatography for the exclusion of choledocholithiasis

Hjartarson

Hannesson

Sverrisson

et al. 2016

Scandinavian Journal of Gastroenterology

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Objective: To investigate the ability of Magnetic resonance cholangiopancreatography (MRCP) to exclude choledocholithiasis (CDL) in symptomatic patients. Material and methods: Patients suspected of choledocholithiasis who underwent MRCP from 2008 through 2013 in a population based study at the National University Hospital of Iceland were retrospectively analysed, using ERCP and/or intraoperative cholangiography as a gold standard diagnosis for CDL. Results: Overall 920 patients [66% women, mean age 55 years (SD 21)] underwent MRCP. A total of 392 patients had a normal MRCP of which 71 underwent an ERCP investigation demonstrating a CBD stone in 29 patients. A normal MRCP was found to have a 93% negative predictive value (NPV) and 89% probability of having no CBD stone demonstrated as well as no readmission due to gallstone disease within six months following MRCP. During a 6-month follow-up period of the 321 patients who did not undergo an ERCP nine (2.8%) patients were readmitted with right upper quadrant pain and elevated liver tests which later normalised with no CBD stone being demonstrated, three (0.9%) patients were readmitted with presumed gallstone pancreatitis, two (0.6%) patients were readmitted with cholecystitis and two (0.6%) patients were lost to follow-up. Seven patients of those 321 underwent an intraoperative cholangiography (IOC) and all were negative for CBD stones. For the sub-group requiring ERCP following a normal MRCP the NPV was 63%. Conclusion: Our results support the use of MRCP as a tool for exclusion of choledocholithiasis with the potential to reduce the amount of unnecessary ERCP procedures. ARTICLE HISTORY

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The value of magnetic resonance cholangiopancreatography for the exclusion of choledocholithiasis

Hjartarson

Hannesson

Sverrisson

et al. 2016

Scandinavian Journal of Gastroenterology

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Improved diagnosis of common bile duct stone with single-shot balanced turbo field-echo sequence in MRCP

et al. 2016

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Comparative performance of non-contrast MRI with HASTE vs. contrast-enhanced MRI/3D-MRCP for possible choledocholithiasis in hospitalized patients

et al. 2017

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Purpose To compare the performance of non-contrast MRI with HASTE versus contrast-enhanced MRI/3D-MRCP for assessment of suspected choledocholithiasis in hospitalized patients. Methods and Materials 123 contrast-enhanced abdominal MRI/MRCP scans in the hospital setting for possible choledocholithiasis were retrospectively evaluated. ERCP, intraoperative cholangiogram or documented clinical resolution served as the reference standard. Readers first evaluated the biliary tree using coronal and axial HASTE and other non-contrast sequences, and later reviewed the entire exam with post-contrast sequences and 3D-MRCP. Test performance for the image sets was compared for choledocholithiasis, acute hepatitis, cholangitis, and acute cholecystitis. Reader agreement, MRCP image quality, and confidence levels were also assessed. Clinical predictors of age and fever were tested for association with perceived need for contrast in biliary assessment. Results There were 27 cases of choledocholithiasis, 31 cases of acute hepatitis, 37 cases of acute cholecystitis, and 3 clinically diagnosed cases of acute cholangitis. Both the abbreviated and full contrast-enhanced/MRCP image sets resulted in high accuracy for choledocholithiasis (91.1–94.3% versus 91.9–92.7%). There was no difference in sensitivity or specificity for either reader for any diagnosis between image sets (p>0.40). 1 reader showed improved confidence (p<0.001) with inclusion of MRCP and contrast-enhanced images, but neither confidence nor MRCP quality scores were associated with diagnostic accuracy. Patient age and fever did not predict the need for contrast-enhanced images. Conclusion In hospitalized patients with suspected choledocholithiasis, performance of non-contrast abdominal MRI with HASTE is similar to contrast-enhanced MRI with 3D-MRCP, offering potential for decreased scanning time and improved patient tolerability.

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The Value of Magnetic Resonance Cholangio-Pancreatography (MRCP) in the Detection of Choledocholithiasis

Cited by 25 publications

References 19 publications

The value of magnetic resonance cholangiopancreatography for the exclusion of choledocholithiasis

The value of magnetic resonance cholangiopancreatography for the exclusion of choledocholithiasis

Improved diagnosis of common bile duct stone with single-shot balanced turbo field-echo sequence in MRCP

Comparative performance of non-contrast MRI with HASTE vs. contrast-enhanced MRI/3D-MRCP for possible choledocholithiasis in hospitalized patients

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