Comparative Evaluation of Magnetic Resonance Cholangiopancreatography and Perioperative Cholangiography in Patients With Suspect Choledocholithiasis

Abstract

Background:Cholelithiasis is a highly prevalent condition, and choledocholitiasis is a high morbidity complication and requires accurate methods for its diagnosis. Aim:To evaluate the population of patients with suspected choledocholitiasis and check the statistical value of magnetic resonance cholangiopancreatography, ultrasonography, the laboratory and the clinic of these patients comparing them to the results obtained by perioperative cholangiography. Methods:This is a retrospective cohort study, which were evaluated 76 patients with cholelithiasis and suspected choledocholithiasis. Results:It was observed that the presence of dilatation of the biliary tract or choledocholithiasis in the ultrasonography was four and eight times increased risk of perioperative cholangiography for positive choledocholithiasis, respectively. For each unit increased in serum alkaline phosphatase was 0.3% increased the risk of perioperative cholangiography for positive choledocholithiasis. In the presence of dilatation of the bile ducts in the ultrasonography was four times greater risk of positive magnetic resonance cholangiopancreatography for choledocholithiasis. In the presence of pancreatitis these patients had five times higher risk of positive magnetic resonance cholangiopancreatography for choledocholithiasis. On the positive magnetic resonance cholangiopancreatography presence to choledocholithiasis was 104 times greater of positive perioperative cholangiography for choledocholithiasis. Conclusions:The magnetic resonance cholangiopancreatography is a method with good accuracy for propedeutic follow-up for the diagnosis of choledocholithiasis, consistent with the results obtained from the perioperative cholangiography; however, it is less invasive, with less risk to the patient and promote decreased surgical time when compared with perioperative cholangiography.

Diagnóstico y tratamiento de coledocolitiasis con diferentes técnicas de imagen

“…Estudios prospectivos, como el de Silva y colaboradores 5 , que comparó el desempeño de CPRE y CRM en 284 pacientes, mostraron resultados similares al estudio multicéntrico del Congreso Quirúrgico de Suroeste 1 , con sensibilidad del 98,3 % y especificidad del 89,7 % para la CRM, con la ventaja de ser menos operador dependiente. Para otros autores, la CRM se ha convertido en el estándar de oro para el estudio de las vías biliares, por su alta precisión en la evaluación de cálculos 6,7 .…”

“…Con este caso queremos mostrar mediante imágenes las limitaciones de la CRM. En pacientes con sospecha de coledocolitiasis y CRM negativa, en quienes no se justifique la invasión endoscópica, una anestesia y estadía intrahospitalaria adicional que significaría realizar una CPRE, la CIO por vía laparoscópica es una opción adecuada, con un desempeño diagnóstico y terapéutico similar, ideal para los pacientes en quienes se requiere realizar también una colecistectomía 7,8 .…”

Evaluación del rendimiento diagnóstico de los criterios predictivos de la sociedad británica para el diagnóstico de coledocolitiasis en una población colombiana

“…En contraste, cuando no se evidenciaron cálculos, la CPRE realizada por alta probabilidad encontró CLDL en el 50 % de los pacientes. Estos resultados difieren con los de publicaciones previas, que han atribuido a la CRM una sensibilidad del 95 %, una especificidad del 84,62 %, un VPP del 70,37 % y un VPN del 97,8 % (25).…”

Puncture and discission with a needle: A new method for laparoscopic common bile duct exploration

“…The CBD diameter was measured using preoperative magnetic resonance cholangiopancreatography rather than perioperative cholangiography. [ 8 ]…”