HPB P41 The incidence and diagnostic potential of Extra-biliary findings on Magnetic Resonance Cholangiopancreatography

Abstract

Abstract Background Magnetic Resonance Cholangiopancreatography (MRCP) is increasingly utilised to assess the biliary tree. This imaging modality can potentially reveal extra-biliary findings that will warrant further urgent investigations. The primary aim of this study was to assess the prevalence of extra-biliary findings on MRCPs. The secondary aim was to assess the need for subsequent investigations and subsequent outcomes. Methods This was a retrospective cohort study of all consecutive MRCPs performed on adult patients in a single centre form September 2021 to September 2022. Patient demographics, indication(s) for MRCP, MRCP result including extra-biliary findings were analysed from electronic case notes. Further analysis of necessary investigations into these extra-biliary findings and outcomes was also undertaken. This study was registered with Clinical Quality Project (LanQIP 14742). Results 495 MRCPs were performed in the study period; 305 (61.6%) were female; median age was 63 years (IQR 50-74). 311 (62.8%) were inpatient and 200 (40.4%) were urgent. 61.2% (n=303) had at least one extra-biliary finding and 8.1% (n=44) required urgent follow-up with 12 having a new diagnosis of malignancy. 19.4% (n=96) had renal cysts, 12.7% (n=63) had hepatic cysts, 5.6% (n=28) had pancreatic cysts, 2.8% (n=14) had liver cirrhosis, 2.8% (n=14) had peripancreatic collections, 3.4% (n=17) had a hiatus hernia, 7.3% (n=36) had pleural effusions, 5.3% (n=26) had splenomegaly and 1.8% (n=9) had identified diverticular disease. Conclusions Each of the extra-biliary findings on MRCP were confirmed with further investigation, which again highlights the high accuracy of Magnetic Resonance Imaging (MRI). It is undeniable that MRCPs are revealing extra-biliary findings which indicate that the diagnosis potential of MRCPs is underestimated. Although MRIs are widely used and has no ionising radiation unlike Computerised Tomography (CT) scans, they are still more costly. Furthermore, it was also noted in previous studies that incidental findings are largely dependent on the reporting radiologist and a structured proforma might be beneficial moving forward.