Abstract
To discern whether preceding ultrasound (US) results, patient demographics and biochemical markers can be implemented as predictors of an abnormal Magnetic Resonance Cholangiopancreatography (MRCP) study in the context of acute pancreaticobiliary disease. A retrospective study was performed assessing US results, age, gender, elevated lipase and biliary enzymes for consecutive patients who underwent an urgent MRCP following an initial US for acute pancreaticobiliary disease between January 2017-December 2018. Multivariable binary logistic regression models were constructed to assess for predictors of clinically significant MRCPs, and discrepant US/MRCP results. A total of 155 patients (mean age 56, 111 females) were included. Age (OR 1.03, P < 0.05), hyperlipasemia (OR 5.33, P < 0.05) and a positive US (OR 40.75, P < 0.05) were found to be independent predictors for a subsequent abnormal MRCP. Contrarily, gender and elevated biliary enzymes were not reliable predictors of an abnormal MRCP, or significant MRCP/US discrepancies. Of 66 cases (43%) of discordant US/MRCPs, half had clinically significant discrepant findings such as newly discovered choledocholithiasis and pancreaticobiliary neoplasia. Age was the sole predictor for a significant US/MRCP discrepancy, with 2% increase in the odds of a significant discrepancy per year of increase in age. An abnormal US, hyperlipasemia and increased age serve as predictors for a subsequent abnormal MRCP, as opposed to gender and biliary enzyme elevation. Age was the sole predictor of a significant US/MRCP discrepancy that provided new information which significantly impacted subsequent management. In the remaining cases, however, MRCP proved useful in reaffirming the clinical diagnosis and avoiding further investigations.
Highlights
Multiple imaging modalities are currently available for pancreaticobiliary tract assessment for a variety of infectious, inflammatory and neoplastic pathologies
The utility of Magnetic Resonance Cholangiopancreatography (MRCP) has already been established in delineating biliary anatomy and the diagnosis of bile duct stones; in 2003, Romagnuolo et al reported an authoritative meta-analysis of 67 published studies, demonstrating that MRCP has an excellent sensitivity of 95% and a specificity of 97% for detecting common bile duct (CBD) stones.[5,6]
From a total of 167 consecutive patients who underwent an urgent MRCP for acute pancreaticobiliary disease in the specified time frame, 12 patients were excluded from the study due to the absence of a preceding ultrasound
Summary
Multiple imaging modalities are currently available for pancreaticobiliary tract assessment for a variety of infectious, inflammatory and neoplastic pathologies. Despite the often asymptomatic nature of cholelithiasis, an estimated 10–15% of symptomatic patients have associated choledocholithiasis.[1] The presence of common bile duct (CBD) stones in the context of acute biliary disease is of critical importance for clinicians as there are multiple potential associated clinical complications (biliary obstruction, pancreatitis, and cholangitis) alongside procedural complications with significantly increased surgical morbidity and mortality.[2] chronic/recurrent choledocholithiasis is a potential risk factor for the development of cholangiocarcinoma.[3]. The utility of Magnetic Resonance Cholangiopancreatography (MRCP) has already been established in delineating biliary anatomy and the diagnosis of bile duct stones; in 2003, Romagnuolo et al reported an authoritative meta-analysis of 67 published studies, demonstrating that MRCP has an excellent sensitivity of 95% and a specificity of 97% for detecting CBD stones.[5,6] MRCP offers a noninvasive alternative to endoscopic retrograde cholangiopancreatography (ERCP) while avoiding potential complications of ERCP such as hemorrhage, pancreatitis and sepsis
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