Magnetic Resonance Cholangiography In Diagnosis Research Articles

Magnetic resonance cholangiography in assessing biliary anatomy in living donors: A meta-analysis

To establish the role of magnetic resonance cholangiography (MRC) in diagnosis of biliary anatomy in living-donor liver transplantation (LDLT) donors. A systematic review was performed by searching electronic bibliographic databases prior to March 2013. Studies with diagnostic results and fulfilled inclusion criteria were included. The methodological quality of the studies was assessed. Sensitivity, specificity and other measures of the accuracy of MRC for diagnosis of biliary anatomy in LDLT donors were summarized using a random-effects model or a fixed-effects model. Summary receiver operating characteristic (SROC) curves were used to summarize overall test performance. Publication bias was assessed using Deek's funnel plot asymmetry test. Sensitivity analysis was adopted to explore the potential sources of heterogeneity. Twelve studies involving 869 subjects were eligible to the analysis. The scores of Quality Assessment of Diagnostic Accuracy Studies for the included studies ranged from 11 to 14. The summary estimates of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic OR of MRC in diagnosis of biliary anatomy in LDLT donor were 0.88 (95%CI: 0.84-0.92), 0.95 (95%CI: 0.93-0.97), 15.33 (95%CI: 10.70-21.95), 0.15 (95%CI: 0.11-0.20) and 130.77 (95%CI: 75.91-225.27), respectively. No significant heterogeneity was detected in all the above four measures. Area under SROC curve was 0.971. Little publication bias was noted across the studies (P = 0.557). Sensitivity analysis excluding a study with possible heterogeneity got a similar overall result, which suggested the little influence of this study on the overall results. Our results suggest that MRC is a high specificity but moderate sensitivity technique in diagnosis of biliary anatomy in LDLT donors.

Diagnostic and follow up value of magnetic resonance cholangiography in biliary complications after orthotopic liver transplantation

To evaluate the diagnostic and follow up value of magnetic resonance cholangiography (MRC) in biliary complications after orthotopic liver transplantation (OLT). MRC was performed, using 1.5 T scanner on 166 consecutive OLT recipients. The MRC results were analyzed and compared with the confirmed diagnosis criteria (direct cholangiography, laparotomy, and liver puncture). The sensitivity, specificity, accuracy, and positive and negative predictive value of MRC in diagnosis of biliary complications were 98.4%, 81.6%, 87.9%, 76.5% and 98.8%. 104 clinically normal cases and 62 symptomatic cases showed 31 and 50 MRC abnormal findings respectively. MRC totally showed 70 cases of suspected biliary complications following OLT, including 41 cases with anastomotic stricture, 8 with focal non-anastomotic stricture, and 12 with stones or debris formation, 2 with bile leak, 3 with cholangitis and 4 with oppressive changes of biliary tract. MRC also showed periportal edema in 11 cases. A good imaging modality to show both periportal edema and biliary abnormality of various patterns, MRC provides important information for post-operational follow up and early detection of biliary complications in OLT recipients.

MRCP Vs ERCP: A Comparative Study in Diagnosis of Common Bile Duct Stones

Background: Because it is a noninvasive method, without complications, the magnetic resonance cholangiography (MRCP) is going to reliably replace ERCP in the diagnosis of pancreato-biliary diseases. Although many studies documented a high sensitivity and specificity of MRCP, its ability in detecting microlithiasis (< 5 mm in diameter) of common bile duct (CBD), responsible for acute biliary pancreatitis, is still controversial. Aim: to evaluate sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV) and negative predictive value (NPV) of MRCP in diagnosis of choledocolithiasis using ERCP + endoscopic sphincterotomy (ES) as the gold standard. Patients and methods: 123 individuals, suspected for lithiasis of CBD were prospectively enrolled in the study. Clinical findings were: jaundice, fever, abdominal and/or biliary pain, weight loss with altered cholestatic enzymes (ALP > 270; Î3-GT > 50 UI/l). Patients underwent upper abdominal ultrasonography (US), then MRCP and, within 72 h, diagnostic and/or operative ERCP. All patients signed an informed consent. The statistical analysis was based on the report of true positives and negatives, false positives and negatives. Results:106/123 patients completed the study. MRCP diagnosed lithiasis of CBD in 73; did not document stones in 33. ERCP confirmed the presence of lithiasis in 66/73 pts who were submitted to ES. Seven were not found to have stones after ES. Among 33 negative pts, ERCP documented stones in 9: in 4 only after ES (it was performed according to clinico-biochemical data and to CBD dilation, though ERCP did not identify stones). The stones were 2-3 mm. In 24/33 patients negative at MRCP, ERCP confirmed this response:10/24 were submitted to ES. ES was not performed in 14/24 subjects, without CBD dilation and/or cholestasis. After a 27.8 months follow-up (range: 4-54), 8/14 remained asymptomatic, 6 underwent laparoscopic cholecystectomy without finding of CBD stones at the intra-operative cholangiography. The sensitivity, specificity, diagnostic accuracy, PPV and NPV of MRCP were: 88%, 77%, 85%, 90%, 73%. Conclusions: as MRCP has still a limitation in the diagnosis of small stones, missed at US, it leaves unrisolved the question of which patient is candidate to ERCP/ES. The recognition of microlithiasis should refer to other imaging techniques preliminar to ERCP (e.g. EUS) though their limited availability makes until now MRCP a method of choice in the diagnosis of biliary disease.