Magnetic resonance cholangiography in patients with biliary disease: its role in primary sclerosing cholangitis

Angulo, Paul; Pearce, Dawn; Johnson, Charles D.; Henry, Jessica J; LaRusso, Nicholas F.; Petersen, Bret T.; Lindor, Keith D.

doi:10.1016/s0168-8278(00)80002-1

Cited by 134 publications

(111 citation statements)

References 16 publications

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“…A regression analysis conducted by Romangnuolo (21) indicated that MRCP accuracy may be higher for patients with a broad spectrum of possible pathologic conditions; however, the reasons for this observation are unclear. Other studies have indicated that MRCP accuracy for CBDS detection is lower in particular populations, for example patients with suspected primary sclerosing cholangitis (1).…”

Section: Discussionmentioning

confidence: 98%

Value of magnetic resonance cholangiopancreatography in the diagnosis of biliary abnormalities in postcholecystectomy patients: A probabilistic cost-effectiveness analysis of diagnostic strategies

Howard

Lord

Speer

et al. 2006

Int J Technol Assess Health Care

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Background: Endoscopic retrograde cholangiopancreatography (ERCP) is considered the gold standard for imaging of the biliary tract but is associated with complications. Less invasive imaging techniques, such as magnetic resonance cholangiopancreatography (MRCP), have a much lower complication rate. The accuracy of MRCP is comparable to that of ERCP, and MRCP may be more effective and cost-effective, particularly in cases for which the suspected prevalence of disease is low and further intervention can be avoided. A model was constructed to compare the effectiveness and cost-effectiveness of MRCP and ERCP in patients with a previous history of cholecystectomy, presenting with abdominal pain and/or abnormal liver function tests. Methods: Diagnostic accuracy estimates came from a systematic review of MRCP. A decision analytic model was constructed to represent the diagnostic and treatment pathway of this patient group. The model compared the following two diagnostic strategies: (i) MRCP followed with ERCP if positive, and then management based on ERCP; and (ii) ERCP only. Deterministic and probabilistic analyses were used to assess the likelihood of MRCP being cost-effective. Sensitivity analyses examined the impact of prior probabilities of common bile duct stones (CBDS) and test performance characteristics.

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Section: Discussionmentioning

confidence: 98%

Value of magnetic resonance cholangiopancreatography in the diagnosis of biliary abnormalities in postcholecystectomy patients: A probabilistic cost-effectiveness analysis of diagnostic strategies

Howard

Lord

Speer

et al. 2006

Int J Technol Assess Health Care

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“…12, 13 Abdalian et al 14 have recently reported the results of a routine screening by way of MRCP of 79 adult patients with AIH. In this study, evidence of large duct SC on MRCP was found in 10% of patients.…”

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confidence: 99%

Prevalence of sclerosing cholangitis in adults with autoimmune hepatitis: A prospective magnetic resonance imaging and histological study

et al. 2009

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The development of sclerosing cholangitis (SC) is observed in up to 50% of children followed up for autoimmune hepatitis (AIH). In adults, the prevalence is less known, although a recent study found evidence of SC in 10% of AIH patients using magnetic resonance cholangiopancreatography (MRCP). The aim of this study was to assess prospectively the prevalence of SC in adults with AIH. Fifty-nine consecutive patients with AIH diagnosed according to International Autoimmune Hepatitis Group score (women, 71%; mean age, 48 years; cirrhosis, 23%) underwent both MRCP and percutaneous liver biopsy. Twenty-seven patients with cirrhosis of nonbiliary or non-autoimmune etiology served as controls. Fourteen AIH patients (24%) showed mild MRCP abnormalities of intrahepatic bile ducts (IHBDs). None had abnormal common bile duct or convincing evidence of SC on MRCP or biopsy. A diagnosis of overlapping SC was nevertheless retained in one patient with MRCP abnormalities who subsequently developed symptomatic cholestasis despite corticosteroid therapy. Fibrosis score was the only independent parameter associated with bile duct abnormalities on MRCP (odds ratio 2.4; 95% confidence interval 1.4-4.7) and the percentage of patients with IHBD MRCP abnormalities was not different among F3-F4 AIH patients (n ‫؍‬ 24) and cirrhotic controls (46% versus 59%; NS). Conclusion: In this cohort of adult patients with AIH, the prevalence of SC was much lower than previously reported (1.7%). Mild MRCP abnormalities of IHBD were seen in a quarter of patients, but these abnormalities resulted from hepatic fibrosis and not SC. In the absence of cholestatic presentation, MRCP screening does not seem justified in adult-onset AIH. (HEPATOLOGY 2009;50:528-537.)

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“…[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%

“…[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. [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%

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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Magnetic resonance cholangiography in patients with biliary disease: its role in primary sclerosing cholangitis

Cited by 134 publications

References 16 publications

Value of magnetic resonance cholangiopancreatography in the diagnosis of biliary abnormalities in postcholecystectomy patients: A probabilistic cost-effectiveness analysis of diagnostic strategies

Value of magnetic resonance cholangiopancreatography in the diagnosis of biliary abnormalities in postcholecystectomy patients: A probabilistic cost-effectiveness analysis of diagnostic strategies

Prevalence of sclerosing cholangitis in adults with autoimmune hepatitis: A prospective magnetic resonance imaging and histological study

The value of magnetic resonance cholangiopancreatography for the exclusion of choledocholithiasis

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