Comparison among the Role of Different Imaging Techniques in Diagnosis of Malignant Lesions Causing Obstructive Jaundice

Abstract

Introduction: The expanding spectrum of therapeutic options for patients with Obstructive /surgical jaundice makes it necessary for the surgeon to precisely assess the etiology, location, level and extent of disease before operation. Aims were to compare the diagnostic accuracy, sensitivity and specificity of different imaging techniques like ultrasonography (USG), Computed tomography (CT) and Magnetic Resonance Cholangiopancreatography (MRCP) and Endoscopic Retrograde Cholangiopancreatography (ERCP) in evaluation of patients with malignant obstructive jaundice and correlation of histopathological findings after surgical/ therapeutic intervention. Methods: It was a prospective observational study conducted in the Department of General Surgery and Hepatobilliary unit, Dhaka Medical College Hospital and Bangabandhu Sheikh Mujib Medical University, Dhaka during January 2015 to December 2015 for duration of one year to find out the role of different imaging techniques in diagnosis of malignant lesions causing obstructive jaundice in 50 cases who fulfilled the inclusion criteria. Initial USG evaluation was followed by CT scan, MRCP and ERCP. The results were read by radiologists blinded to other imaging findings. Surgically fit patients with a stage of resectability should be offered the option of surgical resection for cure. For unresectable malignancies, the choice is between surgical palliation/bypass and ERCP with drainage. The characteristic surgical findings or ERCP features and histopathological diagnosis were recorded methodically as final. Results: Malignant obstructive jaundice is the commonest amongst the males and mean age was 47.56 ± 13.191 and the commonest etiology was Ca head of pancreas (30%). Diagnostic accuracy of MRCP (98%) in the diagnosis of malignant obstructive jaundice was relatively high (98%) as compared to ERCP (89.5%), CT (91.43%), USG (89.97%) in malignant obstructive jaundice respectively. In the diagnosis of malignant diseases, MRCP was more sensitive (95.83%) as compared to ERCP (89%), CT scan (91.67%) and ultrasonography (78.17%). Regarding specificity MRCP (100%) was the high in comparison among ERCP (94%), CT (90.91%) and USG (96.15%).Conclusion: It is concluded that malignant obstructive jaundice is the commonest amongst the males. Ca head of pancreas was the commonest malignant etiology in malignant obstructive jaundice. MRCP was superior to among USG, CT scan or ERCP in studying the malignant lesions. J Bangladesh Coll Phys Surg 2021; 39: 233-240

Diagnostic Accuracy of Ultrasound Sonography Test and Computed Tomography Compared With Magnetic Resonance Cholangio Pancreatography in Patients With Obstructive Jaundice Considering Endoscopic Retrograde Cholangio Pancreatography as Gold Standard

“…This demonstrates that MRCP is an even better diagnostic tool than ERCP. 15 Pramod Chhetri reported an overall diagnostic accuracy of MRCP in benign and malignant causes as 93.98% and 97.6% respectively, which also aligns with our study. 3 A CECT is usually more accurate for determining the type and level of obstruction than an ultrasound scan, however it is less accurate in diagnosing radiolucent calculi.…”

“…Salma et al in his study reported the diagnostic accuracy of CT for malignant obstructive jaundice as 91.43% and sensitivity as 91.67% respectively which is slightly higher than our study. 15 Mahendra Shrestha has reported diagnostic accuracy and sensitivity of CT scan for benign causes of obstructive jaundice as 90%, 84% and for malignant causes, diagnostic accuracy and sensitivity of CT was 82% and 70%. 17 They determined sensitivity of CT to be slightly less than that of our study.…”

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.…”

Role of EUS in Evaluating Causes of Biliary Obstruction not detected by other Imaging Modalities

“…2 The extrahepatic biliary tree can be evaluated with CT, which has the advantages of noninvasiveness, operator independence, and a high technical achievement rate. Nonetheless, CT exposes patients to radiation, and the use of contrast chemicals might cause kidney damage or an allergic reaction.. 3 MRCP is effective for examining the extrahepatic biliary tree. Still, its accuracy suffers when fat planes are few, or the CBD contains little fluid.…”