MR cholangiopancreatography in patients with primary sclerosing cholangitis: interobserver variability and comparison with endoscopic retrograde cholangiopancreatography.

OBJECTIVE The purpose of our study was to determine the degree of interobserver variability and correlation between MR cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) for the presence of bile duct strictures in patients with primary sclerosing cholangitis. MATERIALS AND METHODS For this retrospective study involving 26 patients with primary sclerosing cholangitis, 31 MR cholangiopancreatograms were compared with 30 endoscopic retrograde cholangiopancreatograms. The MR cholangiopancreatograms were independently interpreted by two abdominal radiologists in a blinded, randomized manner for overall image quality, extent of ductal visualization, and the presence and location of bile duct strictures. Unweighted multirater kappa coefficient values were estimated for each comparison. RESULTS Visualization of more than 50% of the expected ductal length was possible in the extrahepatic, central intrahepatic, and peripheral intrahepatic bile ducts in 99%, 88%, and 69% of the MR cholangiopancreatograms and 100%, 86%, and 52% of the endoscopic retrograde cholangiopancreatograms, respectively. Strictures were detected in the extrahepatic, central, and peripheral ducts in 53%, 68%, and 87% of the MR cholangiopancreatograms and 73%, 67%, and 63% of the endoscopic retrograde cholangiopancreatograms, respectively. The interobserver agreement for stricture detection was 61% for MR cholangiopancreatography and 76% for ERCP. MR cholangiopancreatographic findings were consistent with ERCP findings for the presence of strictures in 69% of the cases. CONCLUSION In patients with primary sclerosing cholangitis, MR cholangiopancreatography better shows the bile ducts and can depict more strictures, especially of the peripheral intrahepatic ducts, than ERCP. MR cholangiopancreatography can be used to noninvasively diagnose and follow up patients with primary sclerosing cholangitis.

[1]  R. Nelson,et al.  Radiologic manifestations of sclerosing cholangitis with emphasis on MR cholangiopancreatography. , 2000, Radiographics : a review publication of the Radiological Society of North America, Inc.

[2]  T. Asselah,et al.  MR cholangiography in primary sclerosing cholangitis. , 1998, AJR. American journal of roentgenology.

[3]  A. Sanyal,et al.  Primary sclerosing cholangitis: evaluation with MR cholangiography-a case-control study. , 2000, Radiology.

[4]  J. Sung,et al.  Choledocholithiasis: comparison of MR cholangiography and endoscopic retrograde cholangiography. , 1996, Radiology.

[5]  R. Wiesner,et al.  Primary sclerosing cholangitis: findings on cholangiography and pancreatography. , 1983, Radiology.

[6]  A. Barkun,et al.  Bile duct obstruction and choledocholithiasis: diagnosis with MR cholangiography. , 1995, Radiology.

[7]  R. Nelson,et al.  MR cholangiopancreatography of bile and pancreatic duct abnormalities with emphasis on the single-shot fast spin-echo technique. , 2000, Radiographics : a review publication of the Radiological Society of North America, Inc.

[8]  C. Majoie,et al.  Primary sclerosing cholangitis: a modified classification of cholangiographic findings. , 1991, AJR. American journal of roentgenology.

[9]  F Regan,et al.  Choledocholithiasis: evaluation with MR cholangiography. , 1996, AJR. American journal of roentgenology.

[10]  R. Nelson,et al.  Comparison of MR cholangiopancreatographic techniques with contrast-enhanced cholangiography in the evaluation of sclerosing cholangitis. , 2002, AJR. American journal of roentgenology.

[11]  M A Turner,et al.  Half-Fourier RARE MR cholangiopancreatography: experience in 300 subjects. , 1998, Radiology.

[12]  T. Sauerbruch,et al.  Deterioration of cholestasis after endoscopic retrograde cholangiography in advanced primary sclerosing cholangitis. , 1992, Journal of hepatology.

[13]  J. Fromkes,et al.  Sonographic measurement of the extrahepatic bile duct before and after retrograde cholangiography. , 1985, AJR. American journal of roentgenology.