The value of magnetic resonance cholangiopancreatography for the exclusion of choledocholithiasis

Abstract

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

Diagnostic Potential of Magnetic Resonance Imaging in Chronic Abdominal Pain

“…The utility of MRI as a noninvasive method in detecting gallstones is well established previously, and it clearly outperforms US and CT in depicting ductal stones [23][24][25]. Compared to MRI, abdominal US has also limitations sometimes due to bowel gas or patient's obesity.…”

The Diagnostic Yield of Magnetic Resonance Cholangiopancreatography in the Setting of Acute Pancreaticobiliary Disease — A Single Center Experience

“…14 MRCP, on the other hand, has emerged as a reliable and non-invasive method with superior performance for ductal disease and stones. 15,16 Multiple studies have investigated the role and utility of presurgical MRCP imaging for select patients, based on preceding sonographic findings and biochemical derangements. [17][18][19] Some studies advocated against routine MRCPs for the minor possibility of choledocholithiasis, as it is not cost-effective.…”

The role of intraoperative cholangiography in patients undergoing laparoscopic cholecystectomy for acute gallstone pancreatitis: is magnetic resonance cholangiopancreatography needed?

“…21 However, contrasting evidence is also present in the literature. Several studies advocate the use of MRCP in diagnosing choledocholithiasis in gallstone pancreatitis, [22][23][24] with a sensitivity and specificity reported as 97.98% and 84.4%, respectively, by Shammugam et al, 18 and 82.6% and 97.5%, respectively, by De Waele et al 25 Clearly, variation in management of patients with gallstone pancreatitis exists and there remains a crucial need to establish robust standards for the management of these patients.…”