Title: Role of MRI-MRCP in Evaluation of Obstructive Jaundice

Authors: Arjun Raju P, Divyashree, Surabhi Mehrotra

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i3.08

Abstract

Background- Evaluation of a suspected biliary tract disease is a common surgical problem and traditionally diagnosed by a variety of imaging modalities including Ultrasonography (USG), Computed tomography (CT), Invasive cholangiography and Magnetic Resonance Cholangiopancreatography (MRCP). In a suspected case of biliary obstruction with clinical and laboratory findings suggestive of obstructive jaundice, the main aim of radiologist is to confirm the presence of obstruction and to identify its location, extent and probable cause.

Aim Of Study- To evaluate the diagnostic value of MRCP in studying the sites and causes of obstructive jaundice, and to determine the accuracy of MRCP in the diagnosis of obstructive jaundice.

Materials & Methods- Twenty patients with clinical & biochemical features of obstructive jaundice who presented to the department of radiodiagnosis between October 2015 and September 2016 were enrolled in this study. The final diagnosis was found by endoscopic retrograde cholangiopancreatography (ERCP) and \or surgery and confirmed by histopathology.

Results- MRCP was able to diagnose ductal dilatation and hence, differentiate surgical from medical jaundice in all the patients (100%). MRCP was accurately able to detect the level of obstruction in 100% of cases. The most common cause of obstructive jaundice was pancreatico-biliary tumors (50%), followed by choledocholithiasis (40%). MRCP was accurately able to detect the cause of obstruction in 95% of cases.

Conclusion- Magnetic resonance imaging – magnetic resonance cholangiopancreatography (MRI-MRCP) is a highly sensitive non-invasive technique in the detection of the presence of biliary obstruction in addition to defining its level and cause. The accuracy of magnetic resonance cholangiopancreatography and its non-invasiveness have considerably restricted the diagnostic role of Endoscopic retrograde cholangiopancreatography (ERCP).

Keywords- Obstructive jaundice, MRI, MRCP.

References

1.     1.      Scharsshmidt GF, Goldberg HI, Schmid R. Approach to the patient with cholestatic -jaundice. N Engl J Med. 1983; 308(25): 1515-9.

2.      Rathore et al.; Comparative Study to Assess Diagnostic Reliability of Ultrasou- nd and 3T-MRCP in Patient of Obstructive Jaundice. BJMMR. 2015: 8(11): 919-930.

3.      Glockner JF. Hepatobiliary MRI: current concepts and controversies. J Magn Reson Imaging. 2007; 25(4): 681-95 [PubMed].

4.      Kaltenthaler EC, Walters SJ, Chilott J, Blakerborough A, Vergel YB, Thomas S. MRCP compared to diagnostic ERCP for diagnosis when biliary obstruction is suspected: a systematic review. BMC Med Imaging 2006; 6: 9.

5.      Di Cesare E, Puglielli E, Michelini O, Pistoi MA, Lombardi L, Rossi M, et al. Malignant obstructive jaundice: comparison of MRCP and ERCP in evaluation of distal lesions. Radiol Med 2003; 105: 445-53.

6.      Hekimoglu K, Ustundag Y, Dusak A, Erdem Z, Karademir B, Aydemi S, et al. MRCP vs ERCP in the evaluation of biliary pathologies: review of current literature. J Dig Dis 2008; 9: 162-9.

7.      Iannicceli E, Sessa A, Argnani L, Galluzzo A, David V. [Role of MR Cholangiopanc -reatography in the evaluation of biliary disease]. Clin Ter 2006; 157: 425-9.

8.      Park DH, Kim MH, Lee SS, Lee SK, Kim KP, Han JM, et al. Accuracy of magnetic resonance cholangio-pancreatography for locating hepatolithiasis and detecting accompanying biliary strictures. Endoscopy 2004; 36: 987-92.

9.      Safa Al-Obaidi, Mohammed Ridha Alwan Al-Hilli et al. The Role of Ultrasound and Magnetic Resonance Imaging in the Diagnosis of Obstructive Jaundice. The Iraqi Post Graduate Medical Journal 2007: 6 ( 11).

10.  Bhavesh Goyani, Bhagvati Ukani et al. Ultrasonography and magnetic resonance cholangiopancreatography correlation in patients with obstructive jaundice. IJMSPH 2015 : 4 (7); 1010-1016.

11.  Upadhyaya V, Upadhyaya DN, Ansari MA, Shukla VK. Comparative Assessment Of Imaging Modalities In Biliary Obstruction. Ind J Radiol Imag.2006; 16(4): 577-82.

12.  Rajneesh Madhok, Swinki Rastogi. Role of 3.0 Tesla Magnetic Resonance Cholangiopancreatography in Obstructive Jaundice with Cyto/Histopathological or Surgical Correlation. IJSS 2015; 3( 2).

13.  Mubarak Ali, Ishtiaq Ahmed et al. Diagn- ostic accuracy of magnetic resonance cholangio-pancreatography in evaluation of obstructive jaundice. JPMA 2012; 62: 105.

Corresponding Author

Arjun Raju P

M.D Radiodiagnosis, Department of Radiodiagnosis,

Government Medical College and Susheela Tiwari Memorial Hospital

Haldwani, Uttarakhand-263139

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