The value of magnetic resonance cholangiopancreatography in the detection of choledocholithiasis

Abstract

Background: Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive radiological investigation, performed rapidly, and does not expose the patients to ionized radiation or iodinated contrast material. The present study was conducted to evaluate the role of MRCP in detection of common bile duct (CBD) stones in patients with suspected choledocholithiasis. Materials and Methods: This prospective study included 30 patients with suspicion of choledocholithiasis based on clinical evaluation, biochemical, or radiological investigations. Ultrasonography and MRCP were performed in all patients. All patients underwent open surgery. CBD exploration was performed in all patients, either due to presence of palpable stones or due to the presence of dilated CBD (>7 mm). Demonstration of CBD stones intraoperatively was considered the gold standard for their presence, defined as stones visualized, and extracted or attempted for extraction during surgical CBD exploration. Results: Intraoperatively, 21 (70%) out of 30 patients had cholelithiasis. 26 (86.67%) out of 30 patients had dilated CBD intraoperatively. In 20 (66.67%) out of 30 patients, choledocholithiasis was detected intraoperatively. The sensitivity, specificity, positive, and negative predictive values of ultrasonography in detecting CBD stones in the present study were 65%, 60%, 76.47%, and 46.15%, respectively. The sensitivity, specificity, positive, and negative predictive values of MRCP in diagnosis of CBD stones in the present study were 95%, 90%, 95%, and 90%, respectively. Conclusions: MRCP is a noninvasive investigation without complications and has high sensitivity, specificity, positive, and negative predictive values in detecting CBD stones. MRCP should be done in all cases with suspicion of CBD stones, where facilities and expertise are available.