Specificity Of Magnetic Resonance Cholangiopancreatography Research Articles

The role of magnetic resonance cholangiopancreatography in evaluation of etiological spectrum of obstructive jaundice

Jaundice is a commonly encountered problem in society. Discrimination between obstructive and non-obstructive causes is important to imply surgical intervention in cases of obstructive jaundice whereas medical management in non-obstructive jaundice. Nowadays diagnostic endoscopic retrograde cholangiopancreatography (ERCP) may be replaced by Magnetic resonance cholangiopancreatography (MRCP) as it has high level of resolution and reliability. We studied the role of MRCP in obstructive jaundice to evaluate its etiological spectrums and radiological findings. To evaluate the role of MRCP in the determination of aetiologies in obstructive jaundice, to assess degree and level of biliary obstruction and to correlate MRCP findings with post surgical follow-ups / ERCP/ histopathology. Total sixty-eight patients with a clinical diagnosis of obstructive jaundice referred for MRCP were included in our study. We correlated MRCP findings with the final diagnosis made by post-surgical follow-up / ERCP/ histopathology as a gold standard. For benign lesions, overall sensitivity of MRCP was 97.73%, specificity was 95.83% with an accuracy of 97.06%. MRCP had 94.74% sensitivity, 93.88% specificity, 94.12% accuracy in the diagnosis of choledocholithiasis, and 66.67% sensitivity, 98.39% specificity, and 95.59% accuracy in the diagnosis of benign strictures. For malignant lesions, accuracy, sensitivity, and specificity of MRCP were 97.06%, 95.83%, and 97.73%. MRCP is a highly reliable, accurate, non-invasive imaging technique and has a high sensitivity for the evaluation of aetiologies of obstructive jaundice.

Sensitivity and Specificity of Magnetic Resonance Cholangiopancreatography against Endoscopic Retrograde Cholangiopancreatography in Diagnosing Choledocholithiasis

Background: Various imaging modalities including EUS (Endoscopic ultrasound), CT abdomen (Computed tomography), MRCP (Magnetic resonance cholangiopancreatography), and ERCP (Endoscopic retrograde cholangiopancreatography) are used for diagnosis of choledocholithiasis. ERCP allows direct visualization of bile duct through endoscope, and it also helps in retrieval of stones. On the other hand, MRCP is a noninvasive procedure which uses strong magnetic field to visualize hepatobiliary system. In patients with choledocholithiasis calculi appear as dark filling defects within high signal intensity fluid at MRCP. This study compares the diagnostic accuracy of MRCP in comparison to ERCP in patients with choledocholithiasis. This study aims to compare sensitivity and specificity of MRCP in comparison to ERCP in diagnosing choledocholithiasis.
 Methodology: This comparative cross-sectional study included 170 patients with clinical diagnosis of choledocholithiasis who presented in Liver Center, Holy Family Hospital, Rawalpindi, during the year 2017. Non-probability consecutive sampling technique and a set of established inclusion and exclusion criteria was used to enroll patients. Data was collected by a self-structured questionnaire. Information about the demographic details and findings of ERCP and MRCP were noted on that questionnaire. Data analysis was done using SPSS 25.
 Results: Out of 170 patients, 111 (65.29%) were females and 59 (34.71%) were males. The mean of age for study population was 45.68 with standard deviation (SD) of ±12.40. ERCP confirmed stones in 95 patients while in case of MRCP 87 true positives, 55 true negatives, 20 false positives, and 8 false negatives cases were noted. According to these results, the sensitivity and specificity were 91.6% and 73.3% respectively for MRCP against ERCP. Whereas positive predictive value and negative predictive values were 81.3 and 87.3% respectively for MRCP in comparison to ERCP.
 Conclusion: MRCP has 91.6% sensitivity compared to ERCP. Although MRCP is a comparatively noninvasive procedure, but ERCP remains the diagnostic modality of choice for choledocholithiasis. MRCP could be used in diagnosis of choledocholithiasis instead of ERCP when there are contraindications of ERCP or when no therapeutic role of ERCP is required.
 Recommendations: MRCP should be used when only diagnostic role of ERCP is needed. MRCP should be used when there are contraindications of ERCP. Level of expertise should be increased for MRCP and ERCP.

Ectopic opening of common bile duct into the duodenal bulb: magnetic resonance cholangiopancreatography findings.

PURPOSE We aimed to evaluate the spectrum of magnetic resonance cholangiopancreatography (MRCP) findings in patients with ectopic opening of the common bile duct (CBD) into the duodenal bulb and to determine the effectiveness of the MRCP technique in diagnosis. METHODS Morphologic and morphometric MRCP/MRI features in 16 patients and 36 controls were retrospectively analyzed by 2 radiologists. The frequency of MRCP findings was determined. The significance of the difference between the MRCP observations in patients and controls was evaluated statistically and the diagnostic effectiveness of MRCP was investigated. RESULTS Hook-shaped ending of CBD and bulbar deformity were the most frequent morphologic findings seen on MRCP in the ectopic bulbar opening. Mean pylorus-papilla distance and mean CBD length were significantly shorter and the median diameter of CBD was significantly larger than the control group (patients: 28.6 ± 15.3 mm, 33.7 ± 12.8 mm, 8.6 (2-16) mm; controls: 66.7 ± 11.7 mm, 50.3 ± 14.4 mm, 3.2 (1.5-10) mm, P < .001, respectively). Receiver operating curve analysis showed sensitivity and specificity of MRCP in the diagnosis to be 87.5% and 100%, respectively, if any 3 of the 4 signs (hook-shaped ending of CBD, bulbar deformity, large, and short CBD) were present in a patient whose pylorus-papilla distance was <50 mm. CONCLUSION At MRCP, the presence of short and large CBD with a hook-shaped ending in the deformed duodenal bulb may support the diagnosis of ectopic biliary drainage.

Diagnostic accuracy of magnetic resonance cholangiopancreatography in patients with extrahepatic cholestasis: a retrospective cohort study

Background/Aims: Differential diagnosis of extrahepatic cholestasis can be challenging due to variable sensitivity and specificity rates of imaging techniques. Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive method used for evaluation of biliary tree. We aimed to investigate diagnostic accuracy of MRCP in biliary obstruction. &#x0D; Materials and Methods: Medical records of patients admitted with extrahepatic cholestasis between January 2012 and December 2016 were retrospectively reviewed. Patients who had endoscopic retrograde cholangiopancreatography (ERCP) following MRCP were included. Demographic and clinical characteristics of patients were noted. Final diagnosis of ERCP was accepted as gold standard. Diagnostic efficiency of MRCP was evaluated by calculating sensitivity, specificity, accuracy, negative and positive predictive values as compared with ERCP.&#x0D; Results: There were 615 patients with a mean age of 60.1±17.5 years. Using MRCP, choledocholithiasis, malignant and benign strictures were diagnosed in 337 (54.8%), 101 (16.4%), and 39 patients (6.3%), respectively. Normal MRCP findings were present in 65 patients (10.6%). Final diagnoses via ERCP were as follows: choledocholithiasis (n=390, 63.4%), malignant stricture (n=152, 24.7%), benign stricture (n=62, 10.1%), and normal findings (n=11, 1.8%). Sensitivity and specificity of MRCP were 70.8% and 72.9% for choledocholithiasis, 55.9% and 96.5% for malign stricture, and 16.1% and 94.8% for benign stricture, respectively. Overall accuracy rates were 71.5%, 86.5%, and 86.8% for choledocholithiasis, malign and benign strictures, respectively.&#x0D; Conclusion: Diagnostic accuracy of MRCP is variable for different biliary/cholestatic etiologies. Due to a lower sensitivity for choledocholithiasis, normal MRCP findings should be handled with caution, especially when there is a clinical suspicion for biliary obstruction. &#x0D; Keywords: extrahepatic cholestasis, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, sensitivity, specificity.

Is Cambridge scoring in chronic pancreatitis the same using ERCP and MRCP?: A need for revision of standards.

Grading of chronic pancreatitis (CP) is a clinical and radiologic challenge. Retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) use a version of the Cambridge criteria for ductal evaluation and CP staging, but interchangeability between the modalities lacks validation. This work compares ERCP and MRCP Cambridge scores and evaluates diagnostic performance of MRCP in a large cohort of patients with CP. A large radiology database was searched for CP patients who underwent MRCP between 2003 and 2013. Next, patients who also had an ERCP within 90days of their MRCP were selected. These were categorized into mild, moderate, and severe CP using the standardized Cambridge classification for ERCP. Radiologists blinded to ERCP findings then rated MRCP with modified Cambridge scores. The cohort comprised 325 patients (mean age 51years; 56% female). By ERCP Cambridge classification, 122 had mild CP, 109 moderate CP, and 94 severe CP. MRCP and ERCP showed total agreement of Cambridge score in only 43% of cases. With ERCP as reference, the sensitivity and specificity of MRCP in detecting Cambridge scores 4 + 5 (main-duct predominant) were 75.9% and 64.3%, and for Cambridge score 3 (side-branch predominant) it was 60.0% and 76.9%, respectively. There is a lack of strong concordance between ERCP- and MRCP-based grading of CP using the Cambridge criteria. MRCP had moderate to good performance in diagnosing side-branch predominant versus main-duct predominant CP. This suggests an inherent challenge in comparing literature and calls for a revision of the standards.

Role of Magnetic Resonance Cholangiopancreatography in Patients with Pancreatico-Biliary Diseases

Introduction: Advancements in Magnetic Resonance Cholangiopancreatography (MRCP) technique like development of new pulse sequences and strong magnetic field provided significantly better imaging of pancreatico-biliary diseases with good contrast resolution without any significant artifacts. There is no use of intravenous contrast and it is free of any type of ionizing radiation. As compared to Endoscopic Retrograde Cholangiopancreatography (ERCP) which can only depict the intraluminal pathologies and associated with major complications like pancreatitis, sepsis and even death, MRCP can depict intra-ductal as well as extra ductal pathologies &amp; also it is not associated with any major complication. Aim: The purpose of the present study is to assess diagnostic accuracy of the MRCP in patients with pancreatico-biliary diseases. Materials and Method: A prospective cross-sectional study which included 50 patients with pancreatico biliary diseases who were referred to our department for MRCP and who further underwent ERCP and/or Surgery. Results: Our study consisted of patients of both sexes (14 female &amp; 36 male) with age group ranging from 12 to 84yrs. In the present study the overall sensitivity and specificity of MRCP in diagnosing pancreatico biliary diseases were 97.96% and 100% respectively with a positive predictive value of 100% and negative predictive value of 87.43%. Conclusion: MRCP has high diagnostic accuracy and is almost equivalent to ERCP in diagnosing abnormalities of intrahepatic biliary radicles and common bile duct (CBD). MRCP should be the primary investigation of choice for diagnosis of pancreatico-biliary diseases to plan course of management. ERCP should be reserved for the cases where intervention is required.

2949 Diagnostic Comparison of Magnetic Resonance and Endoscopic Retrograde Cholangiopancreatography in Post-Orthotopic Liver Transplant Patients

INTRODUCTION: In post-liver transplant patients, biliary tract complications are one of the leading causes of morbidity, graft loss and mortality. Many patients with a cholestatic pattern of liver injury or findings of dilated ducts on imaging undergo magnetic resonance cholangiopancreatography (MRCP) as the initial test prior to definitive therapy. The gold standard for diagnosis and treatment is endoscopic retrograde cholangiopancreatography (ERCP). Currently, there are limited studies on the sensitivity and specificity of MRCP at diagnosing biliary complications. Our aim is to assess whether MRCP may prevent unnecessary invasive procedures or aid in the diagnosis of biliary complications. METHODS: This is a retrospective review of patients aged ≥18 years old who underwent a liver transplant at our tertiary level transplant center from January 2007 to December 2017. Of those post-transplant patients, individuals that had both an MRCP and ERCP performed for the same indication were selected. Reports were analyzed to assess for correlation between MRCP and ERCP findings. Other factors analyzed were age, sex, race, cause of prior end-stage liver disease, and liver enzyme levels. RESULTS: A total of 30 patients were included in this study. The mean age of patients was 56 years old with 73% being male. The most common indication for MRCP was abnormal liver function tests (LFTs), followed by transplant rejection (10%), fever (6.7%), abnormal imaging (3.3%), and abnormal biopsy findings (3.3%). Of these patients, 56.7% of MRCP findings correlated with ERCP findings. When divided among indication for MRCP, prior abnormal imaging (i.e., ultrasound or CT) was associated with the highest correlation (80%) between MRCP and ERCP. When an MRCP was performed due to abnormal LFTs, only 57.9% of cases correlated with ERCP findings. The sensitivity and specificity of MRCP in diagnosing biliary pathologies was 59% and 33%, respectively. In most cases, MRCP did not correlate with ERCP findings when it failed to detect an anastomotic stricture that was seen on ERCP. CONCLUSION: MRCP findings more closely correlated with ERCP findings when performed for abnormal prior imaging rather than for abnormal LFTs. Further studies are warranted to determine if MRCPs aid in the diagnosis of biliary disorders or delay time to definitive therapy via ERCP, as these findings suggest that cases of anastomotic strictures may go undiagnosed given the low sensitivity and specificity of MRCP.

Sensitivity and Specificity of Magnetic Resonance Cholangiopancreatography versus Endoscopic Ultrasonography against Endoscopic Retrograde Cholangiopancreatography in Diagnosing Choledocholithiasis: The Indonesian Experience.

Background/AimsBiliary stone disease is one of the most common conditions leading to hospitalization. In addition to endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP) are required in diagnosing choledocholithiasis. This study aimed to compare the sensitivity and specificity of EUS and MRCP against ERCP in diagnosing choledocholithiasis. MethodsThis retrospective study was conducted after prospective collection of data involving 62 suspected choledocholithiasis patients who underwent ERCP from June 2013 to August 2014. Patients were divided into two groups. The first group (31 patients) underwent EUS and the second group (31 patients) underwent MRCP. Then, ERCP was performed in both groups. Sensitivity, specificity, and diagnostic accuracy of EUS and MRCP were determined by comparing them to ERCP, which is the gold standard. ResultsThe male to female ratio was 3:2. The mean ages were 47.25 years in the first group and 52.9 years in the second group. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for EUS were 96%, 57%, 87%, 88%, and 80% respectively, and for MRCP were 81%, 40%, 68%, 74%, and 50%, respectively.ConclusionsEUS is a better diagnostic tool than MRCP for diagnosing choledocholithiasis.

Obstructive jaundice: Its etiological spectrum and radiological evaluation by magnetic resonance cholangiopancreatography

Background: Magnetic resonance cholangiopancreatography (MRCP) has reached a level of resolution and reliability where it may replace diagnostic endoscopic retrograde cholangiopancreatography. We studied the role of MRCP in adult patients with obstructive biliopathy to analyze its etiological spectrum and radiological findings. Materials and Methods: Total fifty patients referred for mrcp with a clinical diagnosis of obstructive jaundice were included in our study. Imaging findings were correlated with the final diagnosis made by histopathological or cytological findings and with the therapeutic outcome. Aim: To evaluate the role of MRCP in the determination of the etiological spectrum, to evaluate level and degree of biliary obstruction in cases of obstructive jaundice and to correlate findings on mrcp with surgical findings where possible. Results: Of fifty patients, 29 were benign lesions and 21 were malignant lesions. Among the benign lesions, 12 had choledocholithiasis and 16 had benign strictures. One case was of a choledochal cyst. Among the malignant lesions, 12 were gallbladder carcinoma, six were cholangiocarcinoma, two were periampullary carcinoma, and one was a case of metastatic deposit. The overall sensitivity of MRCP was 96.5%, specificity was 95.2%, and with an accuracy of 96% for benign lesions. The accuracy, sensitivity, and specificity of MRCP in the diagnosis of benign strictures was 92%, 93.7%, and 91.2%, for choledocholithiasis was 92%, 75%, and 97.3%, and for malignant lesions was 95.2, 96.5%, and 96%, respectively. Conclusion: MRCP is a relatively quick, accurate, and noninvasive imaging modality for the assessment of obstructive jaundice, in ruling out potentially correctable underlying cause.

Su1591 Magnetic Resonance Cholangio-Pancreatography (MRCP) Has Low Sensitivity in Diagnosing Biliary Strictures After Liver Transplantation: a Single Tertiary Care Center Experience

Su1591 Magnetic Resonance Cholangio-Pancreatography (MRCP) Has Low Sensitivity in Diagnosing Biliary Strictures After Liver Transplantation: a Single Tertiary Care Center Experience

Su1590 Role of the Direct PerOral Cholangioscopy Using an Ultra-Slim Endoscope After Endoscopic Extraction of Choledocholithiasis for Detecting Small Bile Duct Lesions Obscure in Conventional Imagings

Su1590 Role of the Direct PerOral Cholangioscopy Using an Ultra-Slim Endoscope After Endoscopic Extraction of Choledocholithiasis for Detecting Small Bile Duct Lesions Obscure in Conventional Imagings

Body Mass Index, Cholecystitis, Cholelithiasis, Pancreatitis and Imaging of Common Bile Duct Stones

PurposeStudies to date have not investigated whether body mass index (BMI) affects the sensitivity and specificity of magnetic resonance cholangiopancreatography (MRCP). The purpose of this study was to investigate the effect of BMi and also concomitant pancreatitis, cholecystitis and cholelithiasis on the sensitivity and specificity of MRCP. Materials and MethodsBetween January 2004 and December 2011, 185 patients were included in the study and divided into 3 groups according to BMI as normal, overweight or obese. Both MRCP and endoscopic retrograde cholangiopancreatography (ERCP) were performed in all patients. ERCP was accepted as the "gold standard." The accuracy, sensitivity and specificity values of the 3 groups were calculated to determine any effects on the results of the MRCP. ResultsBefore separating into groups according to BMI, the statistical results for MRCP in the detection of stone disease were as follows: specificity 74.3%, sensitivity 81.7% and accuracy 79%. After dividing the patients into 3 groups according to BMI, the specificity of stone detection with MRCP in the normal-weight group was 93.8% but decreased to 65.5% in the overweight group and to 72% in the obese group. The sensitivity of stone detection with MRCP in the normal- weight group was 85.2% but decreased to 75% in the overweight group and increased to 88.9% in the obese group. The accuracy was 88.3% in the normal-weight group but decreased to 71.6% in the overweight group and to 81.9% in the obese group. ConclusionOur study showed that MRCP performance was decreased in the overweight and obese groups.

Magnetic Resonance Cholangiopancreatography in the Diagnosis of Pancreas Divisum: A Meta-Analysis of Test Performance

Purpose: Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for diagnosing pancreas divisum (PD). Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive test that can be used to identify PD. However, several epidemiological studies on the diagnostic accuracy of MRCP have yielded conflicting results. The aim of this meta-analysis was to precisely estimate the overall sensitivity and specificity of MRCP alone or with secretin enhancement (S-MRCP) in diagnosing PD. Methods: Two authors independently conducted a comprehensive search of the Cochrane library PUBMED, MEDLINE, and published proceedings from major gastroenterology meetings from January 1980 to June 2012. The reference lists of eligible studies were reviewed for additional studies on the subject. Studies were included if they allowed construction of 2 x 2 contingency tables of MRCP and/or S-MRCP compared with gold standard. Mixed-effect models were used to estimate sensitivity, specificity and quantitative receiver-operating characteristics. Logistic regression was used to examine the influence of publication bias. All analyses were performed using REVMAN 5.1 and IBM SPSS 20. Results: Nine studies involving 1,429 patients were included in the analysis. S-MRCP had a higher overall pooled sensitivity (87%; 95% CI: 84% to 90%; Figure 1) and specificity (97%; 95% CI: 91% to 99%) compared to MRCP (sensitivity [64%; 95% CI: 60% to 67%] and specificity [90%; 85% CI: 84% to 94%]). Table 1 summarizes the diagnostic performance of S-MRCP and MRCP. No major side effects of secretin were noted in these studies.Figure 1: Forest plot of sensitivity of S-MRCP in diagnosing Pancreas Divisum.Table 1: Diagnostic yield of MRCP and S-MRCP in detecting Pancreas DivisumConclusion: The pooled data suggests improved visualization of pancreatic ductal anatomy for detection of PD with secretin stimulation leading to higher overall sensitivity and specificity of S-MRCP. Given its high negative predictive value (NPV) it might be considered as diagnostic test of choice for excluding PD without exposing patients to discomfort and risk associated with ERCP.

The relative roles of magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound in diagnosis of common bile duct calculi: a critically appraised topic

The relative roles of magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS) in the investigation of common bile duct (CD) calculi were evaluated using "evidence-based practice" (EBP) methods. A focused clinical question was constructed. A structured search of primary and secondary evidence was performed. Retrieved studies were appraised for validity, strength and level of evidence (Oxford/CEBM scale: 1-5). Retrieved literature was divided into group A; MRCP slice thickness >or=5 mm, group B; MRCP slice thickness = 3 mm or 3D-MRCP sequences. Six studies were eligible for inclusion (3 = level 1b, 3 = level 3b). Group A: sensitivity and specificity of MRCP and EUS were (40%, 96%) and (80%, 95%), respectively. Group B: sensitivity and specificity of MRCP and EUS were (87%, 95%) and (90%, 99%), respectively. MRCP should be the first-line investigation for CD calculi and EUS should be performed when MRCP is negative in patients with moderate or high pre-test probability.

The relative roles of magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound in diagnosis of malignant common bile duct strictures: a critically appraised topic

The relative roles of magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS) in the investigation of malignant common bile duct (CD) strictures were evaluated using "evidence-based practice" (EBP) methodology. A focused clinical question was constructed. A structured search of primary and secondary evidence was performed. Retrieved studies were appraised for validity, strength and level of evidence (Oxford/CEBM scale: 1-5). Three studies were eligible for inclusion; there were 2 level 3b and 1 level 4 papers. One paper included a patient group appropriate to the question and contained sufficient data to allow analysis. Sensitivity and specificity of MRCP and EUS were (90%, 65%) and (80%, 80%), respectively. In the diagnosis of malignant CD strictures, EUS is more specific than MRCP and may allow cytology to be obtained via a trans-duodenal approach. A multi modality imaging approach is recommended.

Magnetic resonance cholangiopancreatography: a meta-analysis of test performance in suspected biliary disease.

Magnetic resonance cholangiopancreatography (MRCP) is one of many newer noninvasive tests that can image the biliary tree. To precisely estimate the overall sensitivity and specificity of MRCP in suspected biliary obstruction and to evaluate clinically important subgroups. MEDLINE search (January 1987 to March 2003) for studies in English or French, bibliographies, and subject matter experts. Studies were included if they allowed construction of 2x2 contingency tables of MRCP compared with a reasonable gold standard for at least 1 of the following: the presence, level, or cause of biliary obstruction. Two independent observers graded study quality, which included consecutive enrollment, blinding, use of a single (versus composite) gold standard, and nonselective use of the gold standard. Logistic regression was used to examine the influence of publication year, quality score, proportion of patients having a "direct" gold standard, and clinical context on diagnostic performance. Of 498 studies identified, 67 were included (4711 patients). Mixed-effect models were used to estimate the sensitivity and specificity, and quantitative receiver-operating characteristic analysis was performed. Magnetic resonance cholangiopancreatography had a high overall pooled sensitivity (95% [+/-1.96 SD: spread of SD, 75% to 99%]) and specificity (97% [spread of SD, 86% to 99%]). The procedure was less sensitive for stones (92%; odds ratio, 0.51 [CI, 0.35 to 0.75]) and malignant conditions (88%; odds ratio, 0.28 [CI, 0.18 to 0.44]) than for the presence of obstruction. In addition, diagnostic performance was higher in studies that were larger, did not use consecutive enrollment, and did not use gold standard assessment for some patients. Magentic resonance cholangiopancreatography is a noninvasive imaging test with excellent overall sensitivity and specificity for demonstrating the level and presence of biliary obstruction; however, it seems less sensitive for detecting stones or differentiating malignant from benign obstruction.

MRCP for Assessment of Suspected Biliary Tract Disease

Direct cholangiography, most commonly performed at endoscopic retrograde cholangiopancreatography (ERCP), is the gold standard for assessment of suspected biliary tract disease. Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive test that accurately images the biliary tree and may permit some patients to avoid potentially risky diagnostic ERCP. To estimate the sensitivity and specificity of MRCP in suspected biliary obstruction, researchers …

4634 Ercp, mrcp, iocg or expectant management for suspected cbd stone? a cost-utility analysis.

Background: The optimal approach for initial testing in patients with suspected choledocholithiasis (CDL) is uncertain. Availability, cost and technical considerations may influence the role of magnetic resonance cholangiopancreatography (MRCP) and intraoperative cholangiogram (IOCG); the role of endoscopic retrograde cholangiopancreatography (ERCP) may be limited by the risk of complications. Methods: A decision analysis model (TREEAGE version 3.5) utilizing estimates from a published time tradeoff analysis, life table estimates, pooled probability estimates and local costs were used to determine the cost-utility of initial testing strategies in patients with choledocholithiasis: immediate ERCP, IOCG, MRCP or expectant management (EM). Our base case assumed a CDL prevalence of 30% and MRCP sensitivity/specificity of >90%, MRCP/ERCP cost ratio of 0.6 and IOCG/ERCP cost ratio of 0.5. The model was subjected to appropriate one and two-way sensitivity analysis. Results: At our base case, the optimal option for initial investigation of choledocholithiasis was essentially a toss-up between IOCG, MRCP and ERCP. If the prevalence of stone was less than 10.2 %, EM was the optimal choice. At prevalence of stone between 10.2% and 25.2%, IOCG was the optimal strategy. A prevalence of 25.2 to 33.3% marginally favored MRCP. ERCP was the dominant cost effective strategy at all prevalence of stone >33.3%. The model was sensitive to the probability of severe ERCP complications. ERCP was clearly dominant if the sensitivity/ specificity of MRCP was less than 90% or if MRCP/IOCG costs were >64%/51% of the cost of an ERCP respectively. Conclusions: Our analysis suggests that the likelihood of CDL should determine the optimal management strategy. Validated predictive models using biochemical and non-invasive imaging characteristics may be particularly helpful in this regard. Cost-efficacy can be further improved by tailoring the management strategy to local costs and availability of local expertise