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This figure demonstrates a mass lesion located in the left lobe of the liver close to hilus (a) hypointense on T1-weighted MR image, (b) heterogenous hyperintense on T2-weighted image, and (c) heterogenous contrast enhancement on contrast-enhanced fat-saturated T1-weighted image. (d) MRCP image demonstrates the mass that originated from left main bile duct and causes significant bile duct dilatation at the periphery of the liver (arrows). The lesion was considered to be a cholangiocarcinoma with MRI and MRCP findings and also confirmed surgically.
Source publication
In this study, our purpose was to investigate the diagnostic efficacy of the dynamic contrast-enhanced magnetic resonance imaging (MRI) method in the patients with bile duct obstruction.
108 consecutive patients (53 men, 55 women, mean age; 55.77 ± 14.62, range 18-86 years) were included in this study. All the patients underwent conventional upper...
Citations
... Compared with conventional MRI using non-specific CAs, hepatobiliary MRI is known to have considerable advantages in the diagnosis not only of tumours, but also of other liver diseases and related clinical usage, such as biliary tract imaging for pre/post-operative assessment, assessment of liver function and toxicity, and staging of fibrosis and sinusoidal obstruction syndrome [12][13][14]43,44,52,53 . Moreover, a comparative study carried out in macaque monkeys for further verification of the utility of MnFe 2 O 4 -EOB-PEG vs Gd-EOB-DTPA nanoparticles has shown the presence of stronger enhancement in the liver parenchyma and bile duct (CNR: 22.03 vs 3.81 and 19.79 vs 1.88, respectively) and a faster speed (delay time of 10 min vs 30 min) for hepatobiliary MRI. ...
Hepatobiliary magnetic resonance imaging (MRI) can inform the diagnosis of liver tumours in patients with liver cirrhosis and hepatitis. However, its clinical utility has been hampered by the lack of sensitive and specific contrast agents, partly because hepatocyte-specific nanoparticles, regardless of their surface ligands, are readily sequestered by Kupffer cells. Here we show, in rabbits, pigs and macaques, that the performance of hepatobiliary MRI can be enhanced by an ultrasmall nanoparticle composed of a manganese ferrite core (3 nm in diameter) and poly(ethylene glycol)-ethoxy-benzyl surface ligands binding to hepatocyte-specific transmembrane metal and anion transporters. The nanoparticle facilitated faster, more sensitive and higher-resolution hepatobiliary MRI than the clinically used contrast agent gadoxetate disodium, a substantial enhancement in the detection rate (92% versus 48%) of early-stage liver tumours in rabbits, and a more accurate assessment of biliary obstruction in macaques. The nanoparticle’s performance and biocompatibility support the further translational development of liver-specific MRI contrast agents.
... The latter may also provide discrimination between cholesterol and non-cholesterol stones in vivo and is recommended for measuring radiodensity of gallstones before litholytic therapy. Some authors compared magnetic resonance imaging with classical chemical analysis in 32 patients and obtained identical results, with the advantage of visualizing the structure of gallstones with accuracy and in detail [7]. Energydispersive radiographic fluorescence spectrometry is used to determine trace element concentration, particularly calcium and iodine [8]. ...
Background This study aimed to describe the mechanical parameters and chemical composition of gallstones in Egyptian patients having gallstone disease to determine amenability to nonsurgical treatment. These parameters are related to environment, and to date, it is not available for patients living in the Middle East. Materials and methods Three hundred gallstone samples from 39 patients living in Egypt and presented for surgical treatment at Cairo University Hospitals and to the private practice of the first author were included in the study. They were indexed into soft, intermediate, and hard. Each was cut, polished, preserved, and stored in saline. Mechanical parameters were studied and then chemically analyzed to determine cholesterol, calcium, and bilirubin content. Trace metals and elements were determined by particle-induced radiographic emission. Results Except four, all cases were females (mean age: 45.9 years), having a single stone in 64.1%, and multiple in 35.9%. Stones were hard in 13 patients and soft in 26, with mean specific gravity of 0.86 (0.69-1.67). The percentage share for the three major components was as follows: cholesterol 70.8% (43-88), bilirubin 29.5% (10-66), and calcium 2.27% (0.02-7.5). The mean percentage for other elements was as follows: carbon 76.2, hydrogen 10.49, nitrogen 0.51 and sulphur 1.33. Trace metals − in micrograms − were copper (0.0019), iron (0.0108), potassium (0.015), magnesium (0.023), sodium (0.146), and zinc (0.012). Conclusion The patients are good candidates for nonsurgical treatment. In the light of the unique chemical composition of their stones, extracorporeal shockwave lithotripsy is the best. Oral dissolution needs a long time, whereas contact dissolution has no place. Apart from calcium, the concentration of basic elements and metals is of no value for planning treatment.
... MRCP is a noninvasive and non-ionizing imaging modality whereas ERCP is ionizing and invasive, associated with 1-7% of morbidity 13,14 interpretive skills, there are high levels of diagnostic achievements to determine the specific cause of biliary tract or common bile duct obstruction 15,16 . The radiological diagnostic accuracy when combined with clinical data is approaching 98 percent 17 . ...
... Furthermore in the present study there were 83% female patients and 17% male patients. This gender distribution is comparable with the study of Mehmet BN, HuseyinTK,et al 16 where there were 19% male and 81% female patients. ...
To estimate the diagnostic accuracy of MRCP in the detection of bile duct calculi in patients with obstructive jaundice using ERCP as gold standard. It is conclude that Magnetic Resonance Cholangio-Pancreatography (MRCP) is a safe, precise,
relatively fast, with no ionizing radiation and non-invasive imaging modality for the assessment of common bile duct stones in patients of obstructive jaundice. The result of this study recommends that MR Imaging showed high Sensitivity and positive predictive values in the detection of bile duct calculi.
... MRCP is a noninvasive and non-ionizing imaging modality whereas ERCP is ionizing and invasive, associated with 1-7% of morbidity 13,14 interpretive skills, there are high levels of diagnostic achievements to determine the specific cause of biliary tract or common bile duct obstruction 15,16 . The radiological diagnostic accuracy when combined with clinical data is approaching 98 percent 17 . ...
... Furthermore in the present study there were 83% female patients and 17% male patients. This gender distribution is comparable with the study of Mehmet BN, HuseyinTK,et al 16 where there were 19% male and 81% female patients. ...
Objectives:
To estimate the diagnostic accuracy of MRCP in the detection of bile duct calculi in patients with obstructive jaundice using ERCP as gold standard.
Study Design:
This is a cross-sectional study. The study was conducted at Department of Diagnostic Radiology and Imaging Civil Hospital Karachi, from 01-08-2013 to 31-12-2014.
Materials & Methods:
This study comprises 249 cases of clinically observed obstructive jaundice which were referred by hospital consultants or by general practitioner to the Radiology Department for Magnetic Resonance Cholangio-Pancreatography (MRCP). Inclusion criteria were Patients of either gender between 26- 70 years of age with obstructive jaundice, raised direct bilirubin levels of 3 mg/dl and above, raised alkaline phosphatase levels and abdominal ultrasound showed suspicion of stone in dilated or non-dilated common bile duct. Previously Diagnosed cases of Choledocholithiasis, patients of chronic liver disease and those for which MRI is contraindicated such as those with surgical clips, braces were excluded from the study. Standard MRI technique carried out for evaluation of bile duct calculi in obstructive jaundice patients. Its features were carefully evaluated in terms of presence and absence of calculus/calculi, dilatation of CBD and pancreatic duct and presence of intrahepatic cholestasis by the consultant radiologist. Data entered and Statistical analyses were carried out by using SPSS version 17. Sensitivity, specificity, diagnostic accuracy positive and negative predictable values were calculated. Mean and frequency distribution for ages and gender was calculated respectively.
Results:
Mean age of the patients was 45.54 ±11.352 years. Gender distribution shows, 42 patients (17%) were male while remaining 207 patients (83%) were female. True positive cases for stones were 145 (58%) and false positive cases were 80 (32%). Positive predictive value was 91.77%, negative predictive value 87.91% with sensitivity 92.95%, specificity 86.02% and Diagnostic accuracy were found to be 90.36%.
Conclusion:
It is conclude that Magnetic Resonance Cholangio-Pancreatography (MRCP) is a safe, precise, relatively fast, with no ionizing radiation and non-invasive imaging modality for the assessment of common bile duct stones in patients of obstructive jaundice. The result of this study recommends that MR Imaging showed high Sensitivity and positive predictive values in the detection of bile duct calculi.
... Post-cholecystectomy syndrome (PCS) consists of a group of abdominal symptoms that recur and/or persist after cholecystectomy including abdominal pain, dyspepsia, vomiting, gastrointestinal disorders and jaundice, with or without fever and cholangitis. It may occur early or as late as months or years after cholecystectomy [17] . It includes a large number of disorders, both biliary and extra-biliary (gastrointestinal, extra intestinal or psychomotor) in origin that may be even unrelated to cholecystectomy. ...
... It includes a large number of disorders, both biliary and extra-biliary (gastrointestinal, extra intestinal or psychomotor) in origin that may be even unrelated to cholecystectomy. Moreover, in 5% of patients who undergo laparoscopic cholecystectomy, the reason for chronic abdominal pain remains unknown [17] . The reported prevalence of post cholecystectomy complications ranges from very low to 47% [17] . ...
... Moreover, in 5% of patients who undergo laparoscopic cholecystectomy, the reason for chronic abdominal pain remains unknown [17] . The reported prevalence of post cholecystectomy complications ranges from very low to 47% [17] . A relatively common finding after colecystectomy is biliary dilatation and a diameter of the CBD within 10 mm can be regarded as normal [18] . ...
Objective: The aim of this work was to compare the usefulness and sensitivity of ultrasonography (US) and magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of different hepatobiliary disorders.
Methods: The study included 65 patients with various hepatobiliary disorders such as cholelithiasis, post cholecystectomy complications, neoplastic, inflammatory and developmental conditions of the pancreatico-biliary system. All patients underwent an initial abdominal US followed by MRCP, allowing a direct comparison of the results obtained by these two modalities. Correlation was also made with available clinical records, other imaging modalities, intraoperative findings and histopathology results.
Results: While both modalities proved equally sensitive in revealing developmental and inflammatory diseases
of the pancreatico-biliary system (values between 90%-100%), MRCP showed a higher sensitivity for detecting pancreatico-biliary tumors (100% vs. 14.2%; p < .05) and cholelithiasis (96.2% vs. 74.0%; p < .05). MRCP also demonstrated a slightly higher sensitivity in revealing post cholecystectomy complications (92.8% vs. 78.5%), even though the difference did not reach statistical significance (p = .317). A variety of other findings and anatomical variants of the biliary and pancreatic ducts were revealed only by MRCP.
Conclusions: MRCP showed an overall higher sensitivity for revealing hepatobiliary disorders compared to abdominal US. The modality is especially useful when the findings revealed by abdominal US are inconclusive or when clinical suspicion persists despite negative US results.
... Magnetic resonance cholangiopancreatography (MRCP) is the most accurate, noninvasive imaging study for the hepatobiliary system [13] . However, endoscopic retrograde cholangiopancreatography (ERCP) combined with EUS is the gold standard for evaluating hepatobiliary and pancreatic ducts morphology, moreover it allows many therapeutic interventions that carry a greater morbidity and mortality [47] . ...
... MRCP is an abdominal MR imaging method that allows noninvasive visualization of the intra and extrahepatic tree and requires no contrast administration. Recent studies reported that administration of gadoxetic disodium acid or gadobenate dimeglumine improves the sensitivity and specificity of the tool [13,14] . A more recent paper from Choi and Colleagues showed no difference in performance of MRCP with or without contrast medium in detecting biliary stones [15] . ...
... De Waele et al [17] 82.6 97.5 94.2 90.5 95.2 104 pts Shanmugam et al [18] 97.98 84.4 374 pts Moon et al [19] 80 32 pts Kondo et al [20] 88 28 pts Norero et al [21] 97 74 90 89 90 125 pts Scaffidi et al [22] 88 72 83 87 72 140 pts Rahaman et al [1] 84.5 87.4 165 pts Li et al [23] 64 [13] 82 ...
To compare diagnostic sensitivity, specificity and accuracy of magnetic resonance cholangiopancreatography (MRCP) without contrast medium and endoscopic ultrasound (EUS)/endoscopic retrograde cholangiopancreatography (ERCP) for biliary calculi.
From January 2012 to December 2013, two-hundred-sixty-three patients underwent MRCP at our institution, all MRCP procedure were performed with the same machinery. In two-hundred MRCP was done for pure hepatobiliary symptoms and these patients are the subjects of this study. Among these two-hundred patients, one-hundred-eleven (55.5%) underwent ERCP after MRCP. The retrospective study design consisted in the systematic revision of all images from MRCP and EUS/ERCP performed by two radiologist with a long experience in biliary imaging, an experienced endoscopist and a senior consultant in Hepatobiliopancreatic surgery. A false positive was defined an MRCP showing calculi with no findings at EUS/ERCP; a true positive was defined as a concordance between MRCP and EUS/ERCP findings; a false negative was defined as the absence of images suggesting calculi at MRCP with calculi localization/extraction at EUS/ERCP and a true negative was defined as a patient with no calculi at MRCP ad at least 6 mo of asymptomatic follow-up. Biliary tree dilatation was defined as a common bile duct diameter larger than 6 mm in a patient who had an in situ gallbladder. A third blinded radiologist who examined the MRCP and ERCP data reviewed misdiagnosed cases. Once obtained overall data on sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) we divided patients in two groups composed of those having concordant MRCP and EUS/ERCP (Group A, 72 patients) and those having discordant MRCP and EUS/ERCP (Group B, 20 patients). Dataset comparisons had been made by the Student's t-test and χ (2) when appropriate.
Two-hundred patients (91 men, 109 women, mean age 67.6 years, and range 25-98 years) underwent MRCP. All patients attended regular follow-up for at least 6 mo. Morbidity and mortality related to MRCP were null. MRCP was the only exam performed in 89 patients because it did show only calculi into the gallbladder with no signs of the presence of calculi into the bile duct and symptoms resolved within a few days or after colecistectomy. The patients remained asymptomatic for at least 6 mo, and we assumed they were true negatives. One hundred eleven (53 men, 58 women, mean age 69 years, range 25-98 years) underwent ERCP following MRCP. We did not find any difference between the two groups in terms of race, age, and sex. The overall median interval between MRCP and ERCP was 9 d. In detecting biliary stones MRCP Sensitivity was 77.4%, Specificity 100% and Accuracy 80.5% with a PPV of 100% and NPV of 85%; EUS showed 95% sensitivity, 100% specificity, 95.5% accuracy with 100% PPV and 57.1% NPV. The association of EUS with ERCP performed at 100% in all the evaluated parameters. When comparing the two groups, we did not find any statistically significant difference regarding age, sex, and race. Similarly, we did not find any differences regarding the number of extracted stones: 116 stones in Group A (median 2, range 1 to 9) and 27 in Group B (median 2, range 1 to 4). When we compared the size of the extracted stones we found that the patients in Group B had significantly smaller stones: 14.16 ± 8.11 mm in Group A and 5.15 ± 2.09 mm in Group B; 95% confidence interval = 5.89-12.13, standard error = 1.577; P < 0.05. We also found that in Group B there was a significantly higher incidence of stones smaller than 5 mm: 36 in Group A and 18 in Group B, P < 0.05.
Major finding of the present study is that choledocholithiasis is still under-diagnosed in MRCP. Smaller stones (< 5 mm diameter) are hardly visualized on MRCP.
... Not available with full text (8) Review articles (14) Meta-analysis (9) Case reports (2) Articles excluded (n = 15) because they: Did not satisfy the inclusion criteria (6) Did not report sufficient information (3) were meta-analyses (2) Had fewer than 10 participants (1) Were "duplicate" publications (1) Was replay letter (1) Was Chinese paper (1) Figure 1 Flow chart of study selection. [43] 1999 278 MRCP, ERCP 1.5 T MR unit 71 5 5 197 16 11 de Lédinghen et al [44] 1999 32 EUS, MRCP, ERCP 1 T system 10 6 0 16 20 13 Lomas et al [45] 1999 69 MRCP, ERCP 1.5 T MR system 9 2 0 58 13 9 Varghese et al [46] 1999 100 MRCP, ERCP 1.5 GE unit 28 1 2 69 17 12 Stiris et al [47] 2000 50 MRCP, ERCP 1.0 T 28 1 4 17 17 12 Taylor et al [48] 2002 129 MRCP, ERCP 1.5 T MR system 45 9 1 74 18 12 Topal et al [49] 2003 69 MRCP, ERCP 1.5 T MR system 18 0 1 50 14 10 Kejriwal et al [50] 2004 81 MRCP, ERCP Vision 1.5T MRI 20 1 2 58 13 10 Simone et al [51] 2004 [56] 2005 40 CTCh, MRCP 1. 5 T system 12 3 3 22 13 9 Shanmugam et al [57] 2005 [60] 2008 269 MRCP, ERCP 1. 5 T unit 16 0 2 251 19 14 Nandalur et al [61] 2008 95 MRCP, ERCP 1. 5 T system 21 1 7 66 18 13 Norero et al [62] 2008 125 MRCP, ERCP, CT 1.5 T MR system 83 10 3 29 15 11 Srinivasa et al [63] 2010 117 MRCP, ERCP, IOC Siemens Vision 1. 5 T 15 2 8 102 16 12 Bilgin et al [64] 2012 108 MRCP, ERCP, IOC 1. 5 T MR scanner 28 3 6 71 16 11 Zhang et al [65] 2012 70 MRCP, MDCT 1. 5 T MR system 19 2 1 48 18 13 Mandelia et al [66] 2013 30 MRCP, USG 1.5 [43] 1999 Italy 76/202 ERCP, PTC, IOC No Yes No No de Lédinghen et al [44] 1999 France 10/-22 ERCP, IOC Yes Yes Yes Yes Lomas et al [45] 1999 United Kingdom 9/60 ERCP No Yes No Yes Varghese et al [46] 1999 Ireland 30/70 ERCP No Yes Yes Yes Stiris et al [47] 2000 Norway 32/18 ERCP Yes Yes Yes Yes Taylor et al [48] 2002 Australia 46/83 ERCP Yes Yes Yes Yes Topal et al [49] 2003 Belgium 19/50 ERCP, IOC No Yes No No Kejriwal et al [50] 2004 New Zealand 22/59 ERCP No Yes No No Simone et al [51] 2004 France 21/44 ERCP, IOC No Yes Yes Yes Dalton et al [52] 2005 United Kingdom 17/52 ERCP, IOC No Yes No Yes Hallal et al [53] 2005 United States 4/-23 IOC Yes Yes Yes Yes Kondo et al [54] 2005 Japan 24/-4 ERCP Yes Yes Yes Yes Moon et al [55] 2005 South Korea 20/-9 ERCP, IDUS No Yes Yes Yes Okada et al [56] 2005 [60] 2008 Turkey 18/251 ERCP No Yes Yes Yes Nandalur et al [61] 2008 United States 28/67 ERCP, PTC Yes Yes No No Norero et al [62] 2008 Chile 86/39 ERCP No Yes No No Srinivasa et al [63] 2010 Australia 23/104 ERCP, IOC No Yes No No Bilgin et al [64] 2012 Turkey, Germany 34/74 ERCP, PTC No Yes No No Zhang et al [65] 2012 China 20/50 MDCT No Yes Yes No Mandelia et al [66] 2013 India 20/-10 ERCP 0.93, respectively [38] . In this review, we provide high quality systematic evidence for MRCP as a predictor of choledocholithiasis, demonstrating high sensitivity and specificity for predicting CBD stones with high overall accuracy. ...
... Not available with full text (8) Review articles (14) Meta-analysis (9) Case reports (2) Articles excluded (n = 15) because they: Did not satisfy the inclusion criteria (6) Did not report sufficient information (3) were meta-analyses (2) Had fewer than 10 participants (1) Were "duplicate" publications (1) Was replay letter (1) Was Chinese paper (1) Figure 1 Flow chart of study selection. [43] 1999 278 MRCP, ERCP 1.5 T MR unit 71 5 5 197 16 11 de Lédinghen et al [44] 1999 32 EUS, MRCP, ERCP 1 T system 10 6 0 16 20 13 Lomas et al [45] 1999 69 MRCP, ERCP 1.5 T MR system 9 2 0 58 13 9 Varghese et al [46] 1999 100 MRCP, ERCP 1.5 GE unit 28 1 2 69 17 12 Stiris et al [47] 2000 50 MRCP, ERCP 1.0 T 28 1 4 17 17 12 Taylor et al [48] 2002 129 MRCP, ERCP 1.5 T MR system 45 9 1 74 18 12 Topal et al [49] 2003 69 MRCP, ERCP 1.5 T MR system 18 0 1 50 14 10 Kejriwal et al [50] 2004 81 MRCP, ERCP Vision 1.5T MRI 20 1 2 58 13 10 Simone et al [51] 2004 [56] 2005 40 CTCh, MRCP 1. 5 T system 12 3 3 22 13 9 Shanmugam et al [57] 2005 [60] 2008 269 MRCP, ERCP 1. 5 T unit 16 0 2 251 19 14 Nandalur et al [61] 2008 95 MRCP, ERCP 1. 5 T system 21 1 7 66 18 13 Norero et al [62] 2008 125 MRCP, ERCP, CT 1.5 T MR system 83 10 3 29 15 11 Srinivasa et al [63] 2010 117 MRCP, ERCP, IOC Siemens Vision 1. 5 T 15 2 8 102 16 12 Bilgin et al [64] 2012 108 MRCP, ERCP, IOC 1. 5 T MR scanner 28 3 6 71 16 11 Zhang et al [65] 2012 70 MRCP, MDCT 1. 5 T MR system 19 2 1 48 18 13 Mandelia et al [66] 2013 30 MRCP, USG 1.5 [43] 1999 Italy 76/202 ERCP, PTC, IOC No Yes No No de Lédinghen et al [44] 1999 France 10/-22 ERCP, IOC Yes Yes Yes Yes Lomas et al [45] 1999 United Kingdom 9/60 ERCP No Yes No Yes Varghese et al [46] 1999 Ireland 30/70 ERCP No Yes Yes Yes Stiris et al [47] 2000 Norway 32/18 ERCP Yes Yes Yes Yes Taylor et al [48] 2002 Australia 46/83 ERCP Yes Yes Yes Yes Topal et al [49] 2003 Belgium 19/50 ERCP, IOC No Yes No No Kejriwal et al [50] 2004 New Zealand 22/59 ERCP No Yes No No Simone et al [51] 2004 France 21/44 ERCP, IOC No Yes Yes Yes Dalton et al [52] 2005 United Kingdom 17/52 ERCP, IOC No Yes No Yes Hallal et al [53] 2005 United States 4/-23 IOC Yes Yes Yes Yes Kondo et al [54] 2005 Japan 24/-4 ERCP Yes Yes Yes Yes Moon et al [55] 2005 South Korea 20/-9 ERCP, IDUS No Yes Yes Yes Okada et al [56] 2005 [60] 2008 Turkey 18/251 ERCP No Yes Yes Yes Nandalur et al [61] 2008 United States 28/67 ERCP, PTC Yes Yes No No Norero et al [62] 2008 Chile 86/39 ERCP No Yes No No Srinivasa et al [63] 2010 Australia 23/104 ERCP, IOC No Yes No No Bilgin et al [64] 2012 Turkey, Germany 34/74 ERCP, PTC No Yes No No Zhang et al [65] 2012 China 20/50 MDCT No Yes Yes No Mandelia et al [66] 2013 India 20/-10 ERCP 0.93, respectively [38] . In this review, we provide high quality systematic evidence for MRCP as a predictor of choledocholithiasis, demonstrating high sensitivity and specificity for predicting CBD stones with high overall accuracy. ...
To evaluate the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) in patients with choledocholithiasis.
We systematically searched MEDLINE, EMBASE, Web of Science, and Cochrane databases for studies reporting on the sensitivity, specificity and other accuracy measures of diagnostic effectiveness of MRCP for detection of common bile duct (CBD) stones. Pooled analysis was performed using random effects models, and receiver operating characteristic curves were generated to summarize overall test performance. Two reviewers independently assessed the methodological quality of studies using standards for reporting diagnostic accuracy and quality assessment for studies of diagnostic accuracy tools.
A total of 25 studies involving 2310 patients with suspected choledocholithiasis and 738 patients with CBD stones met the inclusion criteria. The average inter-rater agreement on the methodological quality checklists was 0.96. Pooled analysis of the ability of MRCP to detect CBD stones showed the following effect estimates: sensitivity, 0.90 (95%CI: 0.88-0.92, χ (2) = 65.80; P < 0.001); specificity, 0.95 (95%CI: 0.93-1.0, χ (2) = 110.51; P < 0.001); positive likelihood ratio, 13.28 (95%CI: 8.85-19.94, χ (2) = 78.95; P < 0.001); negative likelihood ratio, 0.13 (95%CI: 0.09-0.18, χ (2) = 6.27; P < 0.001); and diagnostic odds ratio, 143.82 (95%CI: 82.42-250.95, χ (2) = 44.19; P < 0.001). The area under the receiver operating characteristic curve was 0.97. Significant publication bias was not detected (P = 0.266).
MRCP has high diagnostic accuracy for the detection of choledocholithiasis. MRCP should be the method of choice for suspected cases of CBD stones.
... Magnetic retrograde colangiopancreatography may offer additional details about papilla of Vater and surrounding structures [13]. Sugita et al. found that Magnetic Resonance (MR) images clearly characterize the normal structures of the ampullary region, including the Oddi muscle, duodenal wall, common bile duct and pancreas [14]. ...
Introduction:
Ampulla of Vater tumors, neoplastic diseases located at the confluence of the common bile duct with the main pancreatic duct; represent 0.2% of all gastrointestinal cancers.
Method:
Retrospective study of all patients admitted in the Emergency Hospital of Bucharest Romania between January 2008 and January 2013, the only selection criterion used being a pathology report which describes an ampulla of Vater carcinoma. We have also performed a review of the medical literature up to 2013, using the PubMed/Medline, Proquest Hospital Collection, Science Direct, Cochrane Library and Web of Science databases. We have used different combinations of the following keywords: "ampulla of Vater", "carcinoma", "resection", reviewing the reference list of retrieved articles for further relevant studies.
Results:
Forty eight patients with ampulla of Vater carcinoma were identified, of whom 59.6% men, 71% from urban areas, and a mean age of 66 ± 13.3 years. Most patients were admitted for obstructive jaundice (49%), right upper quadrant abdominal pain (19%), nausea and loss of appetite in 13%, loss of weight (13%) and upper digestive obstruction in 6% of cases. All patients were evaluated with abdominal transparietal ultrasonography and double contrast, pancreatic protocol, Mutidetector Row Computed Tomography. The abdominal Magnetic Resonance Imaging was performed in 10 cases, upper gastrointestinal endoscopy in 9 cases, and Endoscopic Retrograde Cholangiopancreatography in 39 cases. According to the AJCC Cancer Staging 9% were into stage I, 47% into stage II, 40% into stage III and 4% into stage IV of the disease. The therapeutic approach was surgical for 44 patients and an endoscopic palliation with stent insertion in 4 cases. The surgical procedure was represented by Whipple pancreatoduodenectomy in 27 cases, pylorus preserving pancreatoduodenectomy in 15 cases and exploratory laparotomy in 2 cases. Early morbidity was represented by pancreatic leakage in 4 cases.
Conclusions:
There are clinical scenarios in which it is quite challenging to distinguish a primary ampullary adenocarcinoma based on a preoperative workup. Nevertheless, an aggressive approach should be performed, knowing the higher resectability rates and a five-year survival for these patients. Complete surgical resection should be performed in all medically fit patients, candidates for pancreatoduodenectomy, by a high volume, trained surgeon, able to offer a low morbidity and mortality.
Background: Various imaging modalities including EUS (Endoscopic ultrasound), CT abdomen (Computed tomography), MRCP (Magnetic resonance cholangiopancreatography), and ERCP (Endoscopic retrograde cholangiopancreatography) are used for diagnosis of choledocholithiasis. ERCP allows direct visualization of bile duct through endoscope, and it also helps in retrieval of stones. On the other hand, MRCP is a noninvasive procedure which uses strong magnetic field to visualize hepatobiliary system. In patients with choledocholithiasis calculi appear as dark filling defects within high signal intensity fluid at MRCP. This study compares the diagnostic accuracy of MRCP in comparison to ERCP in patients with choledocholithiasis. This study aims to compare sensitivity and specificity of MRCP in comparison to ERCP in diagnosing choledocholithiasis. Methodology: This comparative cross-sectional study included 170 patients with clinical diagnosis of choledocholithiasis who presented in Liver Center, Holy Family Hospital, Rawalpindi, during the year 2017. Non-probability consecutive sampling technique and a set of established inclusion and exclusion criteria was used to enroll patients. Data was collected by a self-structured questionnaire. Information about the demographic details and findings of ERCP and MRCP were noted on that questionnaire. Data analysis was done using SPSS 25. Results: Out of 170 patients, 111 (65.29%) were females and 59 (34.71%) were males. The mean of age for study population was 45.68 with standard deviation (SD) of ±12.40. ERCP confirmed stones in 95 patients while in case of MRCP 87 true positives, 55 true negatives, 20 false positives, and 8 false negatives cases were noted. According to these results, the sensitivity and specificity were 91.6% and 73.3% respectively for MRCP against ERCP. Whereas positive predictive value and negative predictive values were 81.3 and 87.3% respectively for MRCP in comparison to ERCP. Conclusion: MRCP has 91.6% sensitivity compared to ERCP. Although MRCP is a comparatively noninvasive procedure, but ERCP remains the diagnostic modality of choice for choledocholithiasis. MRCP could be used in diagnosis of choledocholithiasis instead of ERCP when there are contraindications of ERCP or when no therapeutic role of ERCP is required. Recommendations: MRCP should be used when only diagnostic role of ERCP is needed. MRCP should be used when there are contraindications of ERCP. Level of expertise should be increased for MRCP and ERCP.
