MRCP and ERCP in the diagnosis of common bile duct stones

Abstract

Common bile duct stones have been reported to occur in up to 15% of patients with symptomatic gallstones. 1 Ahrendt SA Pitt HA. Biliary tract. in: 16th ed. Sabiston textbook of surgery: the biological basis of modern surgical practice. WB Saunders, Philadelphia2001: 1076-1111 Google Scholar Although the sensitivity of abdominal US for cholelithiasis or gallbladder stones is in excess of 95%, 2 Cooperberg PL Burhenne HJ. Real-time ultrasonography. Diagnostic technique of choice in calculous gallbladder disease. N Engl J Med. 1980; 302: 1277-1279 Crossref PubMed Scopus (202) Google Scholar , 3 Crade M Taylor KJW Rosenfield AT de Graaff CS Minihan P. Surgical and pathologic correlation of cholecystosonography and cholecystography. AJR Am J Roentgenol. 1978; 131: 227-229 Crossref PubMed Scopus (99) Google Scholar , 4 McIntosh DMF Penney HF. Gray scale ultrasonography as a screening procedure in the detection of gallbladder disease. Radiology. 1980; 136: 725-727 Crossref PubMed Scopus (59) Google Scholar reported sensitivities of US for common duct stones range from 18% to 74%. 5 Laing FC. The gallbladder and bile ducts. in: 2nd ed. Diagnostic ultrasound. Mosby-Year Book, St. Louis1998: 175-223 Google Scholar , 6 Mitchell SE Clark RA. A comparison of computed tomography and sonography in choledocholithiasis. AJR Am J Roentgenol. 1984; 142: 729-733 Crossref PubMed Scopus (84) Google Scholar This variable sensitivity is related in part to the operator-dependent nature of US and the obscuration of stones by bowel gas. Sensitivities of conventional CT in the setting of suspected choledocholithiasis range from 76% to 90%. 7 Baron RL. Common bile duct stones: reassessment of criteria for CT diagnosis. Radiology. 1987; 162: 419-424 Crossref PubMed Scopus (108) Google Scholar , 8 Jeffrey RB Federle MP Laing FC Wall S Rego J Moss AA. Computed tomography of choledocholithiasis. AJR Am J Roentgenol. 1983; 140: 1179-1183 Crossref PubMed Scopus (67) Google Scholar In a preliminary report, unenhanced helical CT has been shown to have a sensitivity of 88%, a specificity of 97%, and an accuracy of 94% in the diagnosis of common bile duct stones. 9 Neitlich JD Topazian M Smith RC Gupta A Burrell MI Rosenfield AT. Detection of choledocholithiasis: comparison of unenhanced helical CT and endoscopic retrograde cholangiopancreatography. Radiology. 1997; 203: 753-757 Crossref PubMed Scopus (133) Google Scholar