MR cholangiopancreatography: prospective comparison of a breath-hold 2D projection technique with diagnostic ERCP |
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Authors: | D J Lomas P W P Bearcroft A E Gimson |
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Institution: | (1) University Department of Radiology, Box 219, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK, GB |
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Abstract: | The aim of this study was to compare prospectively a breath-hold projection magnetic resonance cholangiopancreatography (MRCP)
technique with diagnostic endoscopic retrograde cholangiopancreatography (ERCP). Seventy-six patients with suspected strictures
or choledocholithiasis were referred for MRCP and subsequent ERCP examination, which were performed within 4 h of each other.
The MRCP technique was performed using fat-suppressed rapid acquisition with relaxation enhancement (RARE) projection images
obtained in standardised planes with additional targeted projections as required by the supervising radiologist. Two radiologists
(in consensus) assessed the MRCP results prospectively and independently for the presence of bile duct calculi, strictures,
non-specific biliary dilatation and pancreatic duct dilatation, and recorded a single primary diagnosis. The ERCP was assessed
prospectively and independently by a single endoscopist and used as a gold standard for comparison with MRCP. Diagnostic agreement
was assessed by the Kappa statistic. The MRCP technique failed in two patients and ERCP in five. In the remaining 69 referrals
ERCP demonstrated normal findings in 23 cases, strictures in 19 cases, choledocholithiasis in 9 cases, non-specific biliary
dilatation in 14 cases and chronic pancreatitis in 4 cases. The MRCP technique correctly demonstrated 22 of 23 normal cases,
19 strictures with one false positive (sensitivity 100 %, specificity 98 %), all 9 cases of choledocholithiasis with two false
positives (sensitivity 100 %, specificity 97 %), 12 of 14 cases of non-specific biliary dilatation and only 1 of 4 cases of
chronic pancreatitis. There was overall good agreement for diagnosis based on a kappa value of 0.88. Breath-hold projection
MRCP can provide non-invasively comparable diagnostic information to diagnostic ERCP for suspected choledocholithiasis and
biliary strictures and may allow more selective use of therapeutic ERCP.
Received: 20 May 1998; Revision received: 26 November 1998; Accepted: 7 January 1999 |
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Keywords: | : MRI MR cholangiopancreatography ERCP Bile ducts |
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