Details
Category: Volume 08 Issue 02 February 2020
Hits: 971

Title: Evaluation of the role of MRCP and Ultrasound in Diagnosing Obstructive Jaundice

Authors: Dr Snehil Kumar, Dr Pramod Shaha, Dr Amol Gautam, Dr Amol Bhoite, Dr Asif Tamboli, Dr Shrishail Adke, Dr Ruchi, Dr Juilee Phatak

 DOI: https://dx.doi.org/10.18535/jmscr/v8i2.147

Abstract

   

Background: Obstructive jaundice, a common clinical problem which has been documented as one of the leading causes of increased mortality and morbidity. Proper clinical data like history, physical examination, and laboratory tests can differentiate between extrahepatic & intrahepatic obstruction in 90% of patients, imaging modalities are essential in diagnosing the cause and site of obstruction.

The diagnostic accuracy of MRCP gives it strong potential to replace the more invasive procedures like diagnostic ERCP, which should be used only in cases where intervention is being contemplated.

Method: In this present study we have prospectively examined 38 patients with obstructive jaundice using Ultrasound and MRCP.

Results: Of the thirty eight patients, one hundred and one patients had benign causes of obstructive jaundice while fifty two patients had malignant causes of obstructive jaundice. MRCP had an accuracy of 95.45% in detecting the cause of obstructive jaundice while USG had a accuracy of 81.63%. The performance of MRCP when compared to USG was statistically more significant (p<0.05).

Conclusion: Assessment of obstructive jaundice and its cause, site and area of involvement of the lesion, MRCP proves to be better imaging modality over other modalities like ultrasound. It also has added advantage of being non invasive procedure with no ionization radiation.

Keywords: Ultrasound, MRCP, Obstructive jaundice.

References

  1. Fukukura et al: Panctreatic Duct – Morphological evaluation with MRCP after secretin stimulation . Radiology 2002 ;222: 674- 680.
  2. Hunt DR. Common bile duct stones in non dilated bile ducts? An ultrasound study. Astralas Radiol. 1996;40: 221-2.
  3. Liu TH, Consorti ET, Kawashima A, et al. The efficacy of magnetic resonance cholangiography for the evaluation of patients with suspected choledocholithiasis before laparoscopic cholecystectomy. Am J Surg. 1999;178: 480-4.
  4. Lomas DJ, Bearcroft PW, Gimson AE. MR cholangiopancreatography: prospective comparison of a breath hold 2D projection technique with diagnostic ERCP. Eur Radiol. 1999;9: 1411-7.
  5. Shea JA, Berlin JA, Escarce JJ, et al. Revised estimates of diagnostic sensitivity and specificity in biliary tract disease. Arch Intern Med 1994;154:2573-81.
  6. Calvo MM, Bujanda L, Heras I, et al. Magnetic resonance cholangiography versus ultrasound in the evaluation of the gallbladder. J Clin Gastroenterol. 2002 Mar;34(3):233-6.
  7. Coelho JC, Wiederkehr JC (1996) Motility of Oddi's Sphincter: Recent Developments and Clinical Applications. The American Journal of Surgery 172(1):48-51 (PMID: 8686801).
  8. Ahmad et al. Journal of Medical Case Reports (2017) 11:317 DOI 10.1186/s13256-017-1481-2
  9. Inan N, Arslan A, Akansel G, Anik Y, Sarisoy HT, Ciftci E, et al. Diffusionweighted imaging in the differential diagnosis of simple and hydatid cysts of the liver. AJR Am J Roentgenol2007;189:1031–1036. doi: 10.2214/AJR.07.2251
  10. Oruç E, Yõldõrõm N, Topal NB, Kõlõçturgay S, Akgöz S, Savcõ G. The role of diffusion-weighted MRI in the classification of liver hydatid cysts and differentiation of simple cysts and abscesses from hydatid cysts. Diagn Interv Radiol 2010;16:279–287. doi: 10.4261/1305-3825.DIR.2807-09.2
  11. Robledo R, Muro A, Prieto ML. Extrahepatic bileduct carcinoma: ultrasound characteristics and accuracy in demonstration of tumours. Radiology 1996;198:869-73.
  12. Hann LE, Greatrex KV, Bach AM, et al. Cholangiocarcinoma at hepatic hilus: sonographic findings. AJR Am J Roentgenol1997;168:985-89.
  13. Romagnuolo J. Magnetic Resonance Cholangiopancreatography: a metaanalysis of test performance in suspected biliary disease. Ann Intern Med 2003;139:547-57.
  14. Yassa NA, Yang J, Stein S, et al. Gray-scale and color flow sonography of pancreatic ductal adenocarcinoma. J Clin Ultrasound 1997;25:473-80.
  15. Martinez-Noguera A, D’Onofrio M. Ultrsonography of the pancreas. 1. Conventional imaging. Abdom Imaging 2007;32:136-49.
  16. Faria SC, Tamm EP, Loyer EM, et al. Diagnosis and staging of pancreatic tumors. SeminRoentgenol2004;39:397-411.
  17. Tamm EP, Bhosale PR, Lee JH, Pancreatic ductal carcinoma: ultrasound,computed tomography and magnetic resonance imaging features. Semin Ultrasound CT MR 2007;28:330-8.
  18. Tseng JH, Wan YL, Hung CF et-al. Diagnosis and staging of gallbladder carcinoma. Evaluation with dynamic MR imaging. Clin Imaging. 26(3):177-82.
  19. Schwartz LH, Black J, Fong Y et-al. Gallbladder carcinoma: findings atMR imaging with MR cholangiopanc-reatography. J Comput AssistTomogr. 26 (3):405-10.

Corresponding Author

Dr Snehil Kumar

Department of Radiodiagnosis, Krishna Institute of Medical Sciences, Karad, Maharashtra, India