Diagnostic Accuracy of Magnetic Resonance Cholangiopancreatography in Comparison With Endoscopic Retrograde Cholangiopancreatography for Detection of the Etiology of Obstructive Jaundice

Javaria Isram; Ehtesham Haider; Rao Saad Ali Khan; Muhammad Hafeez; Rashk E Hinna; Isfandyar Baig; Aqsa Shahid; Manahil Chaudhry

doi:10.7759/cureus.34484

Diagnostic Accuracy of Magnetic Resonance Cholangiopancreatography in Comparison With Endoscopic Retrograde Cholangiopancreatography for Detection of the Etiology of Obstructive Jaundice

Cureus. 2023 Feb 1;15(2):e34484. doi: 10.7759/cureus.34484. eCollection 2023 Feb.

Authors

Javaria Isram¹, Ehtesham Haider¹, Rao Saad Ali Khan¹, Muhammad Hafeez¹, Rashk E Hinna¹, Isfandyar Baig², Aqsa Shahid¹, Manahil Chaudhry³

Affiliations

¹ Gastroenterology, Pak Emirates Military Hospital (PEMH), Rawalpindi, PAK.
² General Medicine, Royal Bournemouth Hospital, Bournemouth, GBR.
³ General Medicine, The Mid Yorkshire Hospital NHS Trust, Wakefield, GBR.

Abstract

Background: Despite technological advances, obstructive jaundice has significant morbidity and mortality rates. When studying obstructive jaundice, endoscopic retrograde cholangiopancreatography (ERCP), the "gold standard" for biliary obstruction identification, might be replaced with magnetic resonance cholangiopancreatography (MRCP), which is a non-invasive procedure.

Objective: Diagnostic accuracy of MRCP in comparison with ERCP for the detection of the etiology of obstructive jaundice.

Methodology: This prospective, observational study included 102 patients who presented with obstructive jaundice as proven by liver function tests. The MRCP was conducted within 24 to 72 hours before the ERCP. A torso phased-array coil (Siemens, Germany) was used for the MRCP. The duodeno-videoscope and general electric fluoroscopy were used to perform the ERCP. The MRCP was evaluated by a classified radiologist who was blinded to the clinical details. An experienced consultant gastroenterologist who was blinded to the results of the MRCP assessed the cholangiogram of each patient. The hepato-pancreaticobiliary system results from both procedures were compared based on the pathology observed, such as choledocholithiasis, pancreaticobiliary strictures, and dilatation of biliary strictures. We determined the sensitivity, specificity, and negative and positive predictive values with 95% confidence intervals. The statistical significance was set at p<0.05.

Results: The most commonly reported pathology was choledocholithiasis, and MRCP diagnosed 55 patients, of which 53 were true positive cases when compared with the ERCP results of the same patients. MRCP demonstrated greater sensitivity and specificity (respectively) for screening choledocholithiasis (96.2, 91.8), cholelithiasis (100, 75.8), pancreatic duct stricture (100, 100), and hepatic duct mass (100, 100) and showed statistically significant values. The sensitivity of MRCP is lower for identifying benign and malignant strictures, but its specificity was observed to be reliable.

Conclusion: When it comes to determining the severity of obstructive jaundice, both in its early and later stages, the MRCP technique is widely regarded as a reliable means of diagnostic imaging. The diagnostic function of ERCP has been significantly reduced as a result of the precision of MRCP as well as its non-invasive nature. In addition to being a helpful non-invasive method to identify biliary diseases and avoid unnecessary ERCPs and their risks, MRCP offers good diagnostic accuracy for obstructive jaundice.

Keywords: choledocholithiasis; common bile duct (cbd); endoscopic retrograde cholangiopancreatography (ercp); magnetic resonance cholangiopancreatography (mrcp); obstructive jaundice.