胆管腔内超声对鉴别胆管狭窄性质的临床价值研究

目的 探讨胆管腔内超声(IDUS)对于判断胆管狭窄性质的临床应用价值.方法 收集2006年至2010年因胆管狭窄行胆管腔内超声检查后手术患者,将IDUS结果与手术结果进行对照.结果 49例患者中良性狭窄6例,恶性狭窄43例;IDUS判断胆管狭窄性质的敏感度为97.7％( 42/43),特异度为83.3％ (5/6),阳性预测值为97.7％(42/43),阴性预测值为83.3％(5/6),准确性为95.9％(47/49);显著高于传统的影像学检查(B超、CT及MRCP).32例患者曾行胆道刷片检查,其中21例诊断为恶性狭窄,准确率为65.6％.所有胆道刷片诊断为恶性狭窄病例均已经被IDUS所诊断.结论 胆管腔内超声可以有效判断胆管狭窄的性质,指导临床治疗.ERCP术中IDUS基础上行胆道刷片对于胆管恶性狭窄诊断价值有限,但是对于明确病理诊断有一定的帮助.     

胆管腔内超声联合细胞刷检病理、基因突变检测对胆管恶性狭窄的早期定性诊断价值

目的探讨胆管腔内超声（IDUS）联合细胞刷检病理学、细胞刷检标本K-ras和p53基因突变检测对胆管恶性狭窄的早期定性诊断价值。方法84例疑似胆管恶性狭窄患者首先行IDUS检查,随后用细胞刷刷取狭窄段胆管内壁标本,一份送检病理,另一份行K-ras、p53基因突变检测,以病理及随访结果为最终诊断,统计单一检查方法及联合检查方法早期诊断胆管恶性狭窄的敏感度、特异度、阳性预测值、阴性预测值和准确率,并行对比分析。结果单一检查诊断时,IDUS、细胞刷检病理学、细胞刷检标本K-ras基因突变检测和细胞刷检标本p53基因突变检测敏感度分别为63．46％（33／52）、53．85％（28／52）、38．46％（20／52）和42．31％（22／52）,准确率分别为69．05％（58／84）、71．43％（60／84）、61．90％（52／84）和64．29％（54／84）。联合检查诊断时,IDUS＋细胞刷检病理学＋细胞刷检标本K-ras和p53基因突变检测敏感度（96．15％,50／52）、特异度（93．75％,30／32）、阳性预测值（96．15％,50／52）、阴性预测值（93．75％,30／32）和准确率（95．24％,80／84）均最高,且诊断敏感度和准确率均较单一检查诊断时有明显提升（P〈0．05）。结论胆管腔内超声联合细胞刷检病理、细胞刷检标本K-ras和p53基因突变检测有助于胆管恶性狭窄的早期定性诊断。     

胆管腔内超声对胆管狭窄的病因诊断价值探讨

目的探讨胆管腔内超声(IDUS)对胆道狭窄病因诊断的价值。方法应用微型超声探头通过ERCP、经皮经肝胆管造影及手术中直接插管3种途径对32例胆管狭窄病变进行IDUS检查。结果32例胆管狭窄患者中IDUS诊断胆总管癌16例,左肝管癌2例,壶腹癌3例,高位胆管癌1例,慢性胆总管炎6例,胆总管结石2例,胆总管囊肿2例。胆总管癌诊断准确率93.8%,慢性胆总管炎、壶腹癌、肝管癌、胆总管囊肿和胆管癌准确率为100%。结论IDUS对胆管狭窄病因诊断有特殊的价值,通过胆管狭窄不同病变声像图的特征,可以鉴别胆管良、恶性病变,并可判断胆管癌、乳头癌的浸润程度以指导治疗。     

内镜超声检查对胆总管结石的诊断价值

目的 探讨内镜超声检查(EUS)对胆总管结石的诊断价值。方法 回顾性总结近3年来术前B超、CT等检查未能确定胆总管结石而行EUS并经内镜乳头切开术(EST)取石或手术治疗证实者资料，共45例。结果 45例中，EUS诊断胆总管结石43例，另2例诊断胆管轻度扩张，经EST取出高位胆管小结石；EUS诊断胆总管结石者中，2例分别经EST和手术(合并胆囊结石)，胆管内未见结石。其敏感度为95％，阳性预测值为95％。结石最大1、2cm，最小0．3cm，其中≤0．5cm者26例，45例中B超诊断4例可疑胆总管末端结石，2例怀疑壶腹周围占位性病变。CT诊断3例可疑胆总管结石，1例怀疑壶腹占位性病变。结论 EUS在诊断胆总管结石方面，不论胆管是否扩张，不论结石大小，都明显优于B超和CT，尤其是小结石，可与ERCP相媲美，而比ERCP更少侵袭性，更安全。     

胆管腔内超声对胆管良恶性狭窄的鉴别诊断

目的: 探讨胆管腔内超声对良恶性胆道狭窄的鉴别诊断价值.方法: 2006-01/2007-01所有在我院行ERCP及IDUS检查的胆道梗阻患者67例(所有患者随访12-36 mo), 对比影像学诊断差异, 计算IDUS的敏感性, 特异性, 阳性预测值, 阴性预测值及准确性.结果: 手术病理或者细胞学刷检证实为恶性胆管狭窄者共37例, 病理阴性且长期随访证实良性胆管狭窄者共30例, IDUS对胆管恶性狭窄判断的敏感性为89.2%(33/37), 特异性为77.4%(24/31), 阳性预测值为82.5%(33/40), 阴性预测值为88.9%(24/27), 准确性为85.1%(57/67).结论: 胆管腔内超声是一项安全可靠的技术,对胆管良恶性狭窄性质的鉴别有较高的价值.     

经内镜细胞刷检查对胆管恶性狭窄性病变的诊断价值

目的 探讨经内镜细胞刷检查对胆管恶性狭窄性病变的诊断价值,分析影响诊断的因素.方法 对ERCP检查发现可疑胆管恶性狭窄的144例患者行胆管细胞刷检查.2004年-2006年在胆管内来回拉刷10次 2007年-2009年在狭窄部位来回拉刷20次,并重复操作2次.专业病理医师固定阅片,对照术后病理诊断和（或）临床最终诊断,分析细胞刷检查诊断胆管狭窄病变的作用.结果 最终诊断96例为胆管恶性狭窄,48例良性狭窄.恶性狭窄患者中78例细胞刷检查阳性（敏感度81.3%）,18例阴性 良性狭窄患者细胞刷检查均为阴性（特异度100.0%） 总体准确率87.5%.2007年-2009年间恶性狭窄性病变细胞刷检出率为87.7%（50/57）,2004年-2006年间检出率仅为71.8%（28/39）,差异有统计学意义（P＜0.05）.细胞刷检查阳性率与肿瘤来源及狭窄部位无明显关系.术后发生4例轻度胰腺炎、3例胆管炎、2例胆管出血,无严重并发症发生.结论 胆管细胞刷检查对恶性胆管狭窄病变具有较高的特异度和敏感度,于狭窄部位反复拉刷和重复操作有助于提高细胞刷检阳性率.     

胆管癌和良性胆管狭窄的胆管内超声声像学特征比较

目的：通过比较胆管癌和良性胆管狭窄的IDUS声像学特点,总结胆管癌IDUS声像学特征,提高内镜下诊断胆管癌的能力。方法：单中心回顾性病例对照研究,纳入近5年于我院消化内镜中心行ERCP+IDUS检查并明确诊断原发性胆管癌的患者52例,同期行ERCP+IDUS并明确诊断良性胆管狭窄的59例患者作为对照组。收集临床资料、实验室检查、IDUS表现(狭窄长度、回声高低、胆管壁厚度、对称性、胆管壁外膜破坏),比较两组间临床表现、实验室检查结果和IDUS特点。结果：胆管癌和良性胆管狭窄的临床表现和实验室检查结果无明显差异。胆管癌行胆管刷检涂片找到恶性肿瘤细胞占28.9%,胆管内活检确诊胆管癌占40.0%。IDUS显示,胆管癌患者病变胆管壁较良性狭窄者厚(6.8±4.0 VS 4.1±2.3mm,p<0.01)。胆管癌病变胆管壁呈低回声改变、不对称性增厚的比例明显高于良性胆管狭窄组(分别为78.8% VS 44.1%,92.3% VS 50.8%,p<0.01)。此外,胆管癌组有8例(15.4%)IDUS显示胆管壁破坏,良性胆管狭窄组未看到此现象。结论：胆管IDUS声像学改变呈低回声不对称性增厚提示胆管癌,出现胆管壁完整性破坏时应高度怀疑胆管癌。     

超声内镜对胆总管良恶性狭窄的鉴别诊断价值

目的:探讨超声内镜(endoscopic ultrasonography,EUS)对胆总管良恶性狭窄的鉴别诊断价值.方法:回顾性分析39例临床上疑为胆总管狭窄患者EUS检查结果,并与B超、核磁共振成像(magnetic resonance imaging,MRI)检查结果进行比较,根据患者临床资料、组织病理或细胞学诊断及随访结果(≥4 mo)综合确定诊断患者胆总管狭窄的良恶性,从而对比分析EUS对胆总管良恶性狭窄鉴别诊断的价值.结果:39例胆管狭窄患者中恶性病变30例,良性病变9例.EUS、MRI、B超对胆总管良恶性狭窄鉴别诊断的准确率分别为92.3%、76.9%、61.8%,三种方法诊断的准确率比较差异有统计学意义,以EUS最高(P0.05);EUS对胆管狭窄性疾病鉴别诊断的敏感性、特异性、阳性预测值与阴性预测值分别为:96.4%、81.2%、93.1%、90.0%;三种检查相比,敏感性、阴性预测值差异有统计学意义,以EUS最高(均P0.05);特异性、阳性预测值差异无统计学意义(均P0.05).39例患者中4例行超声内镜下细针穿刺(endoscopic ultrasound-guided fineneedle aspiration,EUS-FNA)取得组织病理或细胞学诊断,诊断准确率为100%,与EUS、MRI、B超相比差异有统计学意义,EUSFAN明显高于其他三种检查方法(P0.05).结论:EUS对胆总管良恶性狭窄鉴别诊断率较B超、MRI高,其对胆总管良恶性狭窄鉴别诊断率有一定的提高作用.     

内镜超声检查术对胰腺肿瘤早期诊断的价值

目的探讨内镜超声检查术（EUS）、管内超声检查术（IDUS）及超声内镜引导下细针穿刺术（EUS-FNA）对胰腺肿瘤早期诊断的价值。方法回顾性分析和比较188例胰腺小占位病灶的EUS、IDUS、EUS—FNA及其他影像学检查结果。结果（1）EUS诊断小胰腺癌的准确率是95．6％（44／46）,优于B超58．6％（27／46）、CT77．4％（24／31）、MRI76．2％（16／21）及内镜逆行胰胆管造影术（ERCP）85．3％（29／34）。小胰腺癌EUS声像图主要表现为类圆形、边界清楚、边缘不规则的低回声肿块,内部回声多均匀。（2）25例胰腺小占位病灶行IDUS检查,其准确率是100．0％（25／25）,明显优于B超32．0％（8／25）、CT52．9％（9／17）及MRI57．9％（11／19）等检查。（3）18例胰腺小占位病灶行EUS—FNA,其准确率是66．7％（12／18）。（4）EUS诊断胰腺假性囊肿的准确率是100．0％（27／27）,明显优于13超52．0％（13／25）、CT66、7％（12／18）、MRI82．4％（14／17）及ERCP78．9％（15／19）;对胰腺囊性肿瘤分类鉴别诊断总的准确率是57．7％（15／26）,优于B超19．2％（5／26）、CT36．4％（8／22）、MRI37．5％（6／16）及ERCP50．0％（7／14）等检查。结论EUS、IDUS及EUS-FNA对胰腺肿瘤的早期诊断具有重要价值。     

经皮经肝胆道镜诊断和治疗胆道疾病现状

CT、MRCP以及EUS等影像学技术的发展和普及,使胆道疾病的病因诊断率显著提高,但仍有些病例良恶性狭窄鉴别困难。单纯诊断性ERCP现已明显减少,主要是在治疗ERCP同时进行诊断,而ERCP胆管细胞刷检或活检对恶性病变的阳性率仅约50％。经口胆道镜直视下在病变处活检,可提高正确诊断率,但是在狭窄下方观察,影响狭窄上方病变范围判定。     

胆管腔内超声联合胆汁肿瘤标志物对胆管狭窄病因的诊断价值探讨

目的探讨胆管腔内超声（IDUS）联合胆汁肿瘤标志物测定对胆管狭窄良恶性的鉴别诊断价值。方法57例胆管狭窄患者（良性狭窄8例,恶性狭窄49例）行胆管腔内超声检查,同时行血清及胆汁肿瘤标志物[CA19-9、癌胚抗原（CEA）]测定,以手术病理结果为金标准,统计分析腹部超声、CT、磁共振胰胆管成像术（MRCP）、IDUS以及IDUS联合胆汁肿瘤标记物鉴别诊断胆管狭窄良恶性的敏感度、特异度、阳性预测值、阴性预测值及准确度。结果IDUS和IDUS联合胆汁肿瘤标记物（胆管良恶性鉴别诊断的分界值CA19-9值和CEA值分别为107kU／L和66．71斗∥L）鉴别诊断胆管狭窄良恶性的特异度分别为63．6％（7／11）和77．8％（7／9）（P〉0．05）,阳性预测值分别为91．8％（45／49）和95．9％（47／49）（P〉0．05）,准确度分别为91．2％（52／57）和94．7％（54／57）（P〉0．05）,均显著高于腹部超声、CT和MRCP,差异均有统计学意义（P〈0．05）。IDUS联合胆汁CEA（远端胆管狭窄良恶性鉴别诊断的分界值为71μg/L）鉴别诊断远端胆管狭窄良恶性的准确度为97．9％（46／47）,明显高于IDUS的87．2％（41／47）,差异有统计学意义（P〈0．05）。结论IDUS联合胆汁肿瘤标记物测定对胆管良恶性狭窄性质的鉴别有较高的价值,联合胆汁CEA测定能够在IDUS基础上进一步提高远端胆管恶性狭窄诊断的准确度。     

Preoperative diagnosis of bile duct strictures--comparison of intraductal ultrasonography with conventional endosonography

BACKGROUND: The accuracy of intraductal ultrasonography (IDUS) and endoscopic ultrasonography (EUS) were compared in diagnosing biliary obstruction and in predicting surgical resectability. METHODS: Fifty-six patients with biliary obstruction were investigated preoperatively with both conventional EUS and IDUS. The ultrasonographic miniprobe was inserted into the bile duct system through the working channel of the duodenoscope during endoscopic retrograde cholangiopancreatography (ERCP). Conventional endosonography was performed with echoendoscopes in a standard technique. Images of endoluminal ultrasonography were prospectively reviewed and compared with intraoperative findings and resection specimen analyses. RESULTS: IDUS exceeded EUS in terms of accuracy (IDUS, 89.1%; EUS, 75.6%; P < 0.002), sensitivity (IDUS, 91.1%; EUS, 75.7%; P < 0.002), specificity (IDUS, 80%; EUS, 75%; NS), and T-staging (IDUS, 77.7%; EUS, 54.1%; P < 0.001). In bile duct carcinomas the accuracy rate for lymph node staging using IDUS (60%) is comparable with that using EUS (62.5%). In pancreatic carcinomas, however, lymph node staging using IDUS (13.3%) is significantly (P < 0.002) inferior to EUS (69.2%). Endoluminal ultrasonography may predict the potential resectability of bile duct tumors (IDUS, 81.8%; EUS, 75.6%; P < 0.002). CONCLUSIONS: IDUS proved to be accurate in preoperative diagnosing and T-staging of malignant biliary strictures, whereas it is not suitable for lymph node staging. IDUS using miniprobes during ERCP exceeds conventional EUS in terms of depiction of bile duct obstruction, diagnostic accuracy, and sensitivity and in the prediction of surgical tumor resectability. Additionally, different to EUS, IDUS can conveniently be performed during ERCP in one and the same session.     

Preoperative Diagnosis of Bile Duct Strictures-Comparison of Intraductal Ultrasonography with Conventional Endosonography

Background: The accuracy of intraductal ultrasonography (IDUS) and endoscopic ultrasonography (EUS) were compared in diagnosing biliary obstruction and in predicting surgical resectability. Methods: Fifty-six patients with biliary obstruction were investigated preoperatively with both conventional EUS and IDUS. The ultrasonographic miniprobe was inserted into the bile duct system through the working channel of the duodenoscope during endoscopic retrograde cholangiopancreatography (ERCP). Conventional endosonography was performed with echoendoscopes in a standard technique. Images of endoluminal ultrasonography were prospectively reviewed and compared with intraoperative findings and resection specimen analyses. Results: IDUS exceeded EUS in terms of accuracy (IDUS, 89.1%; EUS, 75.6%; P &lt; 0.002), sensitivity (IDUS, 91.1%; EUS, 75.7%; P &lt; 0.002), specificity (IDUS, 80%; EUS, 75%; NS), and T-staging (IDUS, 77.7%; EUS, 54.1%; P &lt; 0.001). In bile duct carcinomas the accuracy rate for lymph node staging using IDUS (60%) is comparable with that using EUS (62.5%). In pancreatic carcinomas, however, lymph node staging using IDUS (13.3%) is significantly (P &lt; 0.002) inferior to EUS (69.2%). Endoluminal ultrasonography may predict the potential resectability of bile duct tumors (IDUS, 81.8%; EUS, 75.6%; P &lt; 0.002). Conclusions: IDUS proved to be accurate in preoperative diagnosing and T-staging of malignant biliary strictures, whereas it is not suitable for lymph node staging. IDUS using miniprobes during ERCP exceeds conventional EUS in terms of depiction of bile duct obstruction, diagnostic accuracy, and sensitivity and in the prediction of surgical tumor resectability. Additionally, different to EUS, IDUS can conveniently be performed during ERCP in one and the same session.     

管腔内超声对胰胆疾病诊断价值的初探

目的 评价管腔内超声(IDUS)检查在胰胆疾病中的诊断价值.方法 回顾性分析北京协和医院2006年7月至2007年8月期间,对19例胰胆疾病患者的ERCP与IDUS检查结果及其相关临床资料.结果 (1)19例患者中梗阻性黄疸17例,胰腺导管内乳头状黏液瘤(IPMT)2例.17例梗阻性黄疸中胆管癌6例,胰腺癌2例,胆囊癌2例,胆管结石合并胆管狭窄2例,自身免疫性胰腺炎2例,十二指肠乳头腺癌1例,十二指肠乳头腺瘤1例,硬化性胆管炎1例.19例诊断中11例经手术或组织病理学证实.(2)ERCP对胰胆疾病诊断的正确率为73.7%(14/19),IDUS对胰胆疾病诊断的正确率为84.2%(16/19),ERCP联合IDUS对胰胆疾病诊断的正确率89.5%(17/19).(3)ERCP对胆管良恶性狭窄鉴别诊断的敏感性和特异性分别为100.0%(11/11)和83.3%(5/6),IDUS对胆管良恶性狭窄鉴别诊断的敏感性和特异性分别为100.0%(11/11)和100.O%(6/6).(4)ERCP对胆管癌诊断的敏感性和特异性分别为83.3%(5/6)和60.0%(3/5),IDUS对胆管癌诊断的敏感性和特异性分别为100.0%(6/6)和40.0%(2/5).结论 ERCP检查同时进行IDUS检查能提高胰胆疾病的诊断率.IDUS对胆管良恶性狭窄的鉴别诊断具有较高的敏感性和特异性,但在具体区分恶性狭窄的病因上尚存在一定的困难.     

The combination of stricture dilation, endoscopic needle aspiration, and biliary brushings significantly improves diagnostic yield from malignant bile duct strictures.

BACKGROUND: Brush cytology, routinely performed at ERCP to assess malignant-appearing biliary strictures, is limited by relatively low sensitivity and negative predictive value. This study assessed whether the combination of stricture dilation, endoscopic needle aspiration, and biliary brushing improves diagnostic yield. METHODS: In a prospective nonrandomized study, 46 consecutive patients were evaluated with malignant-appearing biliary strictures at ERCP. Twenty-four patients (Group A) underwent standard brush cytology alone and 22 patients (Group B) underwent stricture dilatation to 10F, endoscopic needle aspiration, and subsequent biliary brushing by using the Howell biliary system. The diagnostic yields for both techniques were compared. RESULTS: Of the 46 patients, 34 had proven malignant strictures (14 Group A, 20 Group B). Compared with brushing alone, the combination of stricture dilatation, endoscopic needle aspiration, and subsequent biliary brushing significantly increased both the sensitivity (57% vs. 85%, p < 0.02) and specificity (80% vs. 100%, p < 0.02) of cytology with positive brushings in all patients with pancreatic or gallbladder carcinoma. CONCLUSIONS: The combination of stricture dilation, endoscopic needle aspiration, and biliary brushing significantly improves diagnostic yield for malignant bile duct strictures and may particularly be of benefit for extrinsic strictures caused by pancreatic or gallbladder carcinoma.     

液基细胞学与传统细胞学方法诊断胆总管恶性狭窄的对比研究

目的探讨液基细胞学方法对胆总管恶性狭窄的诊断价值。方法对2008年10月至2009年6月间影像学怀疑为胆总管恶性狭窄的患者进行ERCP胆管细胞刷刷检,分别采用液基细胞学、传统细胞学方法进行细胞学标本制备,比较两种方法诊断的阳性率。结果疑诊胆总管恶性狭窄患者76例,经手术病理、细胞学检测及临床随访最终明确诊断为胆总管恶性狭窄的共65例。32例细胞学检测明确诊断的患者中,传统细胞学方法发现阳性17例（阳性率为26．2％,17／65）、液基细胞学方法发现阳性32例（阳性率为49．2％,32／65）,两者阳性率比较差异有统计学意义（P〈0．05）。结论液基细胞学较传统细胞学方法可提高ERCP胆管细胞刷刷检标本的阳性发现率,具有较高的临床应用价值。     

Prospective evaluation of indeterminate ERCP findings by intraductal ultrasound

BACKGROUND AND AIM: Although the role of intraductal ultrasound (IDUS) in the evaluation of specific disease entities is well known, its utility in evaluating indeterminate findings in a heterogeneous group of patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) is unknown. This study evaluates the diagnostic accuracy of IDUS in patients with indeterminate findings at ERCP. METHODS: This was a prospective study of all patients who underwent IDUS for evaluation of an indeterminate biliary stricture or main pancreatic duct (MPD) dilation noted at ERCP over an 8-month period. The accuracy of IDUS was established based on long-term follow-up, surgery, or further investigations. RESULTS: Twenty-nine (5%) of 600 patients who underwent ERCP had an indeterminate finding that warranted further evaluation by IDUS: this was biliary stricture in 19 patients and MPD dilation in 10. Technical success was 100%. Mean duration of follow-up was 435 days (range 192-614 days). In patients with biliary stricture, IDUS diagnosed 11 as benign and eight as malignant. In patients with MPD dilation, IDUS diagnosed intraductal papillary mucinous tumor in six patients and chronic pancreatitis in four. Findings on IDUS supported the correct diagnosis in 27 of 29 patients (93%). In two patients with dominant hilar stricture in the setting of primary sclerosing cholangitis, IDUS was false positive in one and false negative in the other. One patient died of multiorgan failure due to post-ERCP pancreatitis. CONCLUSIONS: A technically easy procedure, IDUS offers unique advantages in the evaluation of patients with indeterminate findings at ERCP.     

Endoscopic retrograde cholangiopancreatography, intraductal ultrasonography, and magnetic resonance cholangiopancreatography in bile duct strictures: a prospective comparison of imaging diagnostics with histopathological correlation

OBJECTIVES: A variety of imaging techniques are available to diagnose bile duct strictures; the most effective imaging technique, however, has not been established yet. In the present study, we compared the impact of endoscopic retrograde cholangiopancreatography (ERCP), intraductal ultrasonography (IDUS), and magnetic resonance cholangiopancreatography (MRCP) with regard to diagnosing bile duct strictures. METHODS: We prospectively examined 33 patients with jaundice due to bile duct strictures by ERCP plus IDUS and MRCP. The objectives were to assess diagnostic quality of imaging, complete presentation of the bile duct, and differentiation of malignant from benign lesions. Surgical and histopathological correlations, which were used as the gold standard, were available in all cases since all included patients underwent laparotomy. RESULTS: Diagnostic image quality for ERCP was 88% and 76% for MRCP (p > 0.05). Comparing ERCP and MRCP, complete presentation of the biliary tract was achieved in 94% and 82%, respectively (p > 0.05). ERCP and MRCP allowed correct differentiation of malignant from benign lesions in 76% and 58% (p= 0.057), respectively. By supplementing ERCP with IDUS, the accuracy of correct differentiation of malignant from benign lesions increased significantly to 88% (p= 0.0047). CONCLUSIONS: Comparing ERCP with MRCP, we found adequate presentation of bile duct strictures in high imaging quality for both techniques. ERCP supplemented by IDUS gives more reliable and precise information about differentiation of malignant and benign lesions than MRCP alone without additional imaging sequences.