title: The decision-making value of magnetic resonance cholangiopancreatography in patients seen in a referral center for suspected biliary and pancreatic disease.
abstract: OBJECTIVE
  To assess the ability of MRCP to alter the differential diagnosis and to prevent diagnostic and/or therapeutic ERCP. The diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) for biliary and pancreatic disease is well documented. Some believe MRCP may prevent diagnostic ERCP or add useful information, however there are no reports of its impact on clinical management.
  
  
  METHODS
  Consecutive patients referred for ERCP underwent clinic evaluation, then MRCP, and then ERCP. In Phase 1, the number of differential diagnoses and the perceived need for diagnostic ERCP were evaluated after each step by the endoscopist who performed the ERCP. In Phase 2, the process was repeated after presenting clinical information and MRCP results to different individual physicians: another endoscopist, a hepatologist, a radiologist, and a surgeon (all were blinded to ERCP results).
  
  
  RESULTS
  Forty patients were enrolled. Clinical contexts were jaundice (19.7%), abnormal liver enzymes (42.6%), abdominal pain (11.5%), recurrent acute pancreatitis (11.5%), and suspected complications of chronic pancreatitis (14.7%). In Phase 1, adding MRCP information to diagnostic ERCP information did not change the mean number of differential diagnoses significantly and prevented no therapeutic ERCP. In Phase 2, adding MRCP to clinical information only (without ERCP) reduced the differential diagnosis significantly for the radiologist and the surgeon only and would have prevented < or =3% of diagnostic and therapeutic ERCP for all physicians.
  
  
  CONCLUSIONS
  The value of MRCP information may be limited if patient selection is inappropriate and may differ in physicians depending on their speciality.
authors.affiliation: Department of Radiology, Medical University of South Carolina, Charleston, USA.
authors.forename: A V
authors.initials: AV
authors.lastname: Sahai
authors.forename: D
authors.initials: D
authors.lastname: Devonshire
authors.forename: K G
authors.initials: KG
authors.lastname: Yeoh
authors.forename: C
authors.initials: C
authors.lastname: Kay
authors.forename: D
authors.initials: D
authors.lastname: Feldman
authors.forename: I
authors.initials: I
authors.lastname: Willner
authors.forename: J
authors.initials: J
authors.lastname: Farber
authors.forename: R
authors.initials: R
authors.lastname: Patel
authors.forename: P R
authors.initials: PR
authors.lastname: Tamasky
authors.forename: J T
authors.initials: JT
authors.lastname: Cunningham
authors.forename: T
authors.initials: T
authors.lastname: Trus
authors.forename: R H
authors.initials: RH
authors.lastname: Hawes
authors.forename: P B
authors.initials: PB
authors.lastname: Cotton
mesh_terms: D001660:Biliary Tract Diseases / Q000175:diagnosis*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003657:Decision Making; D003937:Diagnosis, Differential; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D010182:Pancreatic Diseases / Q000175:diagnosis*; D010819:Physician's Role; D011860:Radiography, Abdominal / Q000379:methods*; D012017:Referral and Consultation