Role of Magnetic Resonance Cholangio-Pancreaticography in Differentiating between Benign and Malignant Causes of Biliary Obstruction

Abstract

Background: the initial evaluation of obstructive jaundice involves distinguishing between intra and extra hepatic biliary obstruction. The goal of any radiologic procedure is to confirm the presence of biliary obstructive by detecting biliary dilatation, its exact location, extent and probable cause. Aim of the Study: to evaluate the role of Magnetic Resonance Cholangio-Pancreatography in differentiating benign from malignant causes of biliary obstruction using surgical, ERCP or histopathological findings as a gold standard.Patients and Methods: a prospective study done on 20 patients with clinical and laboratory finding suggestive of biliary obstruction. All patients underwent non enhanced MRCP on 1.5 Tesla machine (Philips). The final diagnosis of MRCP was correlated with results of ERCP in addition to biopsy and histological diagnosis to those patients had neoplasms. Results: Out of 20 cases, there were 11 benign and 9 malignant cases. Mean age of patients with malignant obstruction was more than benign with slight female preponderance. The diagnostic accuracy of MRCP in differentiating benign from malignant biliary obstructive diseases in correlation with surgical, ERCP and histopathological outcome was85.7%, 96.3%, and 93.3% respectively. It was found that irregular, asymmetric and long segment narrowing was more common in malignant stricture. Conclusion: MRCP is a rapid and non-invasive, procedure in assessing cases with suspicions biliary obstructions. It offered a diagnostic accuracy nearly equivocal to ERCP. MRCP can also replace the diagnostic part of ERCP procedure, so that time is spent only on its th erapeutic part, and hence decreasing complications of a lengthy ERCP. Recommendations: benign or malignant nature of biliary obstruction can be assured by MRCP by observation of stricture margin, dilatation, and length and accordingly proceed to next step in management. MRCP is an efficient diagnostic procedure for detection of presence, level, cause of obstruction and routinely advocated before any intervention is planned.