Diagnostic utility of MRCP in obstructive jaundice and comparison with CT & ultrasonography

Abstract

Introduction: With availability of multiple therapeutic options accessible to patients with obstructive jaundice, it is crucial to convey vital information through radiological investigations to decide further management plan. Apart from confirming presence of obstruction in biliary tract and identifying its cause whether benign or malignant, imaging can provide details about anatomical level of obstruction, extent of the pathology as well as its amenability to interventional procedures. Aim and Objective: To evaluate the diagnostic accuracy of Magnetic Resonance Cholangiopancreatography (MRCP) compared with Ultrasound and Computed Tomography (CT) in patients with obstructive jaundice taking findings of ERCP/ PTC and histopathology as gold standard.Materials and Methods: This prospective study included 36 patients who were referred to the department of radio-diagnosis with clinical features of obstructive jaundice.Initial ultrasonography (USG) was followed by Computed tomography (CT) and Magnetic Resonance Cholangiopancreatography (MRCP), however in cases of benign pathologies where USG findings were unequivocal Computed tomography (CT) was not done to avoid unnecessary radiation exposure. The reporting was done by radiologists blinded to other imaging findings. The characteristic Endoscopic Retrograde Cholangiopancreatography (ERCP) features/ histopathological diagnosis (as applicable) were considered as final.Results: For diagnosing the cause of obstructive jaundice, MRI with MRCP has a greater diagnostic accuracy of 94.4% than CT with accuracy is 91.6% and USG with diagnostic accuracy of 30.56%.Conclusion: Ultrasound is a good screening modality to confirm biliary obstruction and to decide whether MRCP is required as next step or not. MRCP is a highly useful non-invasive imaging study in the pre-operative workup of cases with obstructive jaundice.