scholarly journals Use of magnetic resonance cholangiography in the diagnosis of choledocholithiasis: prospective comparison with a reference imaging method

Gut ◽  
1999 ◽  
Vol 44 (1) ◽  
pp. 118-122 ◽  
Author(s):  
S H Zidi ◽  
F Prat ◽  
O Le Guen ◽  
Y Rondeau ◽  
L Rocher ◽  
...  
Keyword(s):  
Bile Duct ◽  
Magnetic Resonance ◽  
Predictive Value ◽  
Endoscopic Retrograde Cholangiography ◽  
Magnetic Resonance Cholangiography ◽  
Imaging Method ◽  
Bile Duct Stones ◽  
Endoscopic Retrograde ◽  
Standard Equipment ◽  
Prospective Comparison

BackgroundMagnetic resonance cholangiography (MRC) is a new technique for non-invasive imaging of the biliary tract.AimTo assess the results of MRC in patients with suspected bile duct stones as compared with those obtained with reference imaging methods.Patients/Methods70 patients (34 men and 36 women, mean (SD) age 71 (15.5) years; median 75) with suspected bile duct stones were included (cholangitis, 33; pancreatitis, three; suspected post-cholecystectomy choledocholithiasis, nine; cholestasis, six; stones suspected on ultrasound or computed tomography scan, 19). MR cholangiograms with two dimensional turbo spin echo sequences were acquired. Endoscopic retrograde cholangiography with or without sphincterotomy (n = 63), endosonography (n = 5), or intraoperative cho- langiography (n = 2) were the reference imaging techniques used for the study and were performed within 12 hours of MRC. Radiologists were blinded to the results of endoscopic retrograde cholangiography and previous investigations.Results49 patients (70%) had bile duct stones on reference imaging (common bile duct, 44, six of which impacted in the papilla; intrahepatic, four; cystic duct stump, one). Stone size ranged from 1 to 20 mm (mean 6.1, median 5.5). Twenty seven patients (55%) had bile duct stones smaller than 6 mm. MRC diagnostic accuracy for bile duct lithiasis was: sensitivity, 57.1%; specificity, 100%; positive predictive value, 100%; negative predictive value, 50%.ConclusionsStones smaller than 6 mm are still often missed by MRC when standard equipment is used. The general introduction of new technical improvements is needed before this method can be considered reliable for the diagnosis of bile duct stones.

scholarly journals Endoscopic ultrasound versus endoscopic retrograde cholangiography for the diagnosis of choledocholithiasis: the influence of the size of the stone and diameter of the common bile duct

2005 ◽  
Vol 42 (4) ◽  
pp. 239-243 ◽  
Author(s):  
Marcus Vinicius Silva Ney ◽  
Fauze Maluf-Filho ◽  
Paulo Sakai ◽  
Bruno Zilberstein ◽  
Joaquim Gama-Rodrigues ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Ultrasound ◽  
Common Bile Duct Stones ◽  
Endoscopic Retrograde Cholangiography ◽  
Bile Duct Stones ◽  
Endoscopic Retrograde ◽  
The Common ◽  
Common Bile Duct Diameter

BACKGROUND: Endoscopic retrograde cholangiography is highly accurate in diagnosing choledocholithiasis, but it is the most invasive of the available methods. Endoscopic ultrasonography is a very accurate test for the diagnosis of choledocholithiasis with a risk of complications similar to that of upper gastrointestinal endoscopy. AIM: To compare the accuracy of endoscopic ultrassonography and endoscopic retrograde cholangiography in the diagnosis of common bile duct stones before laparoscopic cholecystectomy and to analyze endoscopic ultrasound results according to stone size and common bile duct diameter. PATIENTS AND METHODS: Two hundred and fifteen patients with symptomatic gallstones were admitted for laparoscopic cholecystectomy. Sixty-eight of them (31.7%) had a dilated common bile duct and/or hepatic biochemical parameter abnormalities. They were submitted to endoscopic ultrassonography and endoscopic retrograde cholangiography. Sphincterotomy and sweeping of the common bile duct were performed if endoscopic ultrassonography or endoscopic retrograde cholangiography were considered positive for choledocholithiasis. After sphincterotomy and common bile duct clearance the largest stone was retrieved for measurement. Endoscopic or surgical explorations of the common bile duct were considered the gold-standard methods for the diagnosis of choledocholithiasis. RESULTS: All 68 patients were submitted to laparoscopic cholecystectomy with intraoperative cholangiography with confirmation of the presence of gallstones. Endoscopic ultrassonography was a more sensitivity test than endoscopic retrograde cholangiography (97% vs. 67%) for the detection of choledocholithiasis. When stones >4.0 mm were analyzed, endoscopic ultrassonography and endoscopic retrograde cholangiography presented similar results (96% vs. 90%). Neither the size of the stone nor the common bile duct diameter had influence on endoscopic ultrasonographic performance. CONCLUSIONS: For a group of patients with an intermediate or moderate risk with respect to the likelihood of having common bile duct stones, endoscopic ultrassonography is a better test for the diagnosis of choledocholithiasis when compared to endoscopic retrograde cholangiography mainly for small-sized calculi.

The Role of Magnetic Resonance Cholangiopancreatography in the Diagnosis of Choledocholithiasis: Do Benefits Outweigh the Costs?

2015 ◽  
Vol 81 (7) ◽  
pp. 720-725 ◽  
Author(s):  
William H. Ward ◽  
Laura M. Fluke ◽  
Benjamin D. Hoagland ◽  
Gregory J. Zarow ◽  
Jenny M. Held ◽  
...  
Keyword(s):  
Bile Duct ◽  
Magnetic Resonance ◽  
Length Of Stay ◽  
Common Bile Duct ◽  
Predictive Value ◽  
Demographic Data ◽  
Common Bile Duct Stones ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Biliary Tree ◽  
Bile Duct Stones

Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard in evaluation of the biliary tree for choledocholithiasis. Formal indications for magnetic resonance cholangiopancreatography (MRCP) in suspected choledocholithiasis are lacking. Our objective was to determine if MRCP affects management of patients who otherwise would undergo ERCP. A review was conducted of all MRCPs and ERCPs at our institution from 2008 to 2012 with suspected choledocholithiasis. Patients who underwent MRCP and ERCP were compared with those who underwent ERCP alone. Demographic data were collected and notation of whether a post-MRCP ERCP occurred was the primary variable. MRCP was performed in 107 patients for choledocholithiasis. Eighty-eight patients were negative for choledocholithiasis (82%) and 76 were discharged without ERCP (71%). Thirty-one patients received a diagnosis of choledocholithiasis and were referred for ERCP. Of the 19 patients with MRCP-diagnosed common bile duct stones, 95 per cent were confirmed by ERCP (odds ratio 18.0, P > 0.05; agreement 77%, sensitivity 0.76, specificity 0.86, positive predictive value 0.95, negative predictive value 0.50). Length of stay was similar for all groups. A total of 131 patients underwent ERCP without a preprocedural MRCP. Choledocholithiasis was found in 116 patients (92%), whereas 12 patients (9%) had no common bile duct stones and three had an alternate diagnosis. In conclusion, MRCP significantly affected the management of patients who would have undergone ERCP. MRCP did not increase length of stay and contributed to the 95 per cent positivity rate of subsequent ERCPs. These data illustrate the utility of MRCP in suspected choledocholithiasis patients at a low cost with regard to risk and time.

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