Use of Magnetic Resonance Cholangiopancreatography in Clinical Practice: Not as Good as We Once Thought

Aydelotte, Jayson; Ali, Jawad; Huynh, Phuong Tu; Coopwood, Thomas B.; Uecker, John; Brown, Carlos

doi:10.1016/j.jamcollsurg.2015.01.060

Cited by 38 publications

(43 citation statements)

References 25 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It must be noted that many studies reporting low sensitivity and/or NPV of MRCP are more than a decade old and might be outdated due to the technological advancements of MRCP in the period following their publication.…”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%

“…[4,23,24] However, two recent studies have not demonstrated high NPV of a negative MRCP to exclude CDL. [13,17] In clinical practise, it is of major importance to exclude CBD stones in order to avoid unnecessary ERCPs. [6,21] Thus, the clinical problem we wanted to address in the current study was the reliability of a normal MRCP investigation for the exclusion of common bile duct stones.…”

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%

“…[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: 95%

“…[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%

See 4 more Smart Citations

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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