Prospective assessment of magnetic resonance cholangiopancreatography for noninvasive imaging of the biliary tree.

BACKGROUND Traditionally, ERCP has been the only reliable method for imaging the biliary tree, but it is invasive and carries a risk of complications. Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive method for imaging the biliary tree. The aim of this study was to prospectively assess the accuracy of MRCP in a large number of patients. METHODS Consecutive patients referred to a teaching hospital for ERCP were eligible for study entry. MRCP was performed within 24 hours before ERCP. MRCP findings were compared with ERCP findings or, when the initial ERCP was unsuccessful, with results of repeat ERCP, percutaneous transhepatic cholangiography, or surgery. RESULTS One hundred forty-six patients underwent 149 ERCP/MRCP procedures, of which 129 were evaluable with successful MRCP and ERCP or an ERCP-equivalent study. Diagnoses included choledocholithiasis in 46 and biliary stricture in 12 patients. The sensitivity, specificity, positive, and negative predictive values for MRCP in the diagnosis of choledocholithiasis were 97.9%, 89.0%, 83.6%, and 98.6%, respectively. All 12 strictures were diagnosed by MRCP (sensitivity 100%, specificity 99.1%). CONCLUSIONS MRCP is an accurate, noninvasive alternative to ERCP for imaging the biliary tree. Choledocholithiasis and biliary strictures can be reliably diagnosed or excluded by MRCP. MRCP should be used increasingly in patients with suspected biliary obstruction to select those who require a therapeutic procedure.

[1]  M. Reiser,et al.  Breath-hold MR cholangiography with snapshot techniques: prospective comparison with endoscopic retrograde cholangiography. , 1998, Radiology.

[2]  I. Durieu,et al.  Sclerosing cholangitis in adults with cystic fibrosis: a magnetic resonance cholangiographic prospective study. , 1999, Journal of hepatology.

[3]  R. Lecesne,et al.  Diagnosis of choledocholithiasis: EUS or magnetic resonance cholangiography? A prospective controlled study. , 1999, Gastrointestinal endoscopy.

[4]  J F Riemann,et al.  A prospective evaluation of magnetic resonance cholangiopancreatography in patients with suspected bile duct obstruction , 1998, Gut.

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

[6]  Y. Atomi,et al.  Anomalous pancreaticobiliary junction without congenital choledochal cyst , 1998, The British journal of surgery.

[7]  William S. McCune,et al.  Endoscopic cannulation of the ampulla of Vater: a preliminary report. By William S. McCune, Paul E. Shorb, and Herbert Moscovitz, 1968. , 1968, Gastrointestinal endoscopy.

[8]  F. Prat,et al.  Prospective controlled study of endoscopic ultrasonography and endoscopic retrograde cholangiography in patients with suspected common-bileduct lithiasis , 1996, The Lancet.

[9]  D. Menzies,et al.  Operative common bile duct imaging by operative cholangiography and flexible choledochoscopy , 1992, The British journal of surgery.

[10]  L Rocher,et al.  Use of magnetic resonance cholangiography in the diagnosis of choledocholithiasis: prospective comparison with a reference imaging method , 1999, Gut.

[11]  B. V. Van Beers,et al.  Extrahepatic biliary obstruction: magnetic resonance imaging compared with endoscopic ultrasonography. , 2000, Endoscopy.

[12]  M Hareyama,et al.  Mucin-producing pancreatic tumors: comparison of MR cholangiopancreatography with endoscopic retrograde cholangiopancreatography. , 1998, Radiology.

[13]  R Felix,et al.  Clinical Significance of Magnetic Resonance Cholangiopancreatography (MRCP) Compared to Endoscopic Retrograde Cholangiopancreatography (ERCP) , 1997, Endoscopy.

[14]  A. Barkun,et al.  Pancreas divisum: evaluation with MR cholangiopancreatography. , 1996, Radiology.

[15]  C. Frazer,et al.  Magnetic resonance cholangiopancreatography following liver transplantation. , 1999, Australasian Radiology.

[16]  M. Sivak,et al.  Endoscopic ultrasonography versus cholangiography for the diagnosis of choledocholithiasis. , 1998, Gastrointestinal endoscopy.

[17]  J. Varghese,et al.  The diagnostic accuracy of magnetic resonance cholangiopancreatography and ultrasound compared with direct cholangiography in the detection of choledocholithiasis. , 1999, Clinical radiology.

[18]  A. Shimakawa,et al.  Evaluation of malignant biliary obstruction: efficacy of fast multiplanar spoiled gradient-recalled MR imaging vs spin-echo MR imaging, CT, and cholangiography. , 1994, AJR. American journal of roentgenology.

[19]  D. Sautereau,et al.  Value of MR cholangiography in the diagnosis of obstructive diseases of the biliary tree: a study of 58 cases , 1998, American Journal of Gastroenterology.

[20]  K. Kopecky,et al.  Intravenous cholangiography with helical CT: comparison with endoscopic retrograde cholangiography. , 1994, Radiology.

[21]  J. Soto,et al.  MR cholangiopancreatography after unsuccessful or incomplete ERCP. , 1996, Radiology.

[22]  J. Soto,et al.  Magnetic resonance cholangiography: comparison with endoscopic retrograde cholangiopancreatography. , 1996, Gastroenterology.

[23]  Y H Auh,et al.  Extrahepatic biliary diseases: 3D MR cholangiopancreatography compared with endoscopic retrograde cholangiopancreatography. , 1997, Radiology.

[24]  D. J. Lomas,et al.  MR cholangiopancreatography: prospective comparison of a breath-hold 2D projection technique with diagnostic ERCP , 1999, European Radiology.

[25]  T. Asselah,et al.  Caroli's Disease: A Magnetic Resonance Cholangiopancreatography Diagnosis , 1998, American Journal of Gastroenterology.

[26]  D. Adams,et al.  Comparison of endoscopic retrograde cholangiopancreatography with MR cholangiopancreatography in patients with pancreatitis. , 1999, Radiology.

[27]  P. Desmond,et al.  Imaging of the normal and abnormal pancreaticobiliary system with single-shot MR cholangiopancreatography: a pictorial review. , 1999, Australasian radiology.

[28]  M Takahashi,et al.  MR cholangiopancreatography using HASTE (half-Fourier acquisition single-shot turbo spin-echo) sequences. , 1996, AJR. American journal of roentgenology.

[29]  M Paley,et al.  MR cholangiography: clinical evaluation in 40 cases. , 1993, Radiology.

[30]  W Weidenmaier,et al.  Dilated biliary tract: evaluation with MR cholangiography with a T2-weighted contrast-enhanced fast sequence. , 1991, Radiology.

[31]  J Vandervoort,et al.  Role of endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis in patients undergoing laparoscopic cholecystectomy. , 1998, Gastrointestinal endoscopy.

[32]  R Schöfl,et al.  Three-dimensional spiral CT cholangiography in patients with suspected obstructive biliary disease: comparison with endoscopic retrograde cholangiography. , 1996, Radiology.

[33]  P. Fina,et al.  Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. , 1998, Gastrointestinal endoscopy.

[34]  F Regan,et al.  MR cholangiography in biliary obstruction using half-Fourier acquisition. , 1996, Journal of computer assisted tomography.