The role of magnetic resonance cholangiography in the management of patients with gallstone pancreatitis.
OBJECTIVE
To examine the utility of magnetic resonance cholangiography (MRC) in the preoperative evaluation of patients with gallstone pancreatitis.


BACKGROUND
Gallstone pancreatitis is often associated with the presence of common bile duct (CBD) stones that may require endoscopic removal prior to planned laparoscopic cholecystectomy. No reliable clinical criteria exist, however, that can accurately predict CBD stones and the need for preoperative endoscopic retrograde cholangiopancreatography (ERCP).


METHODS
Sixty-four patients were identified with gallstone pancreatitis based on clinical presentation and imaging studies over a three-and-a-half-year period. All patients underwent MRC, and the images were evaluated for gallstones, CBD stones, cholecystitis, and pancreatitis


RESULTS
Seventeen of the 64 patients (27%) with gallstone pancreatitis were found to have CBD stones confirmed by ERCP. MRC correctly predicted CBD stones in 16 of the 17 patients (sensitivity = 94%). In 1 additional patient, MRC demonstrated CBD stones not seen at ERCP, consistent with probable passage. By comparison, the sensitivities of other criteria for predicting CBD stones were (1) elevated bilirubin >or=2.0 mg/dL = 65%; (2) dilated duct on ultrasound = 55%; and (3) CBD stones on ultrasound = 27%. MRC was able to visualize gallbladder stones in 57 of 62 patients (94%) and correctly predicted acute cholecystitis in 6 of 8 patients. MRC also detected peripancreatic edema and inflammatory changes consistent with acute pancreatitis in 45 of 64 patients (70%).


CONCLUSIONS
These results demonstrate that MRC can accurately identify CBD stones preoperatively in patients with gallstone pancreatitis and provide valuable information with respect to other biliary pathology, including cholelithiasis, acute cholecystitis, and pancreatitis. MRC is an effective noninvasive screening tool for CBD stones, appropriately selecting candidates for preoperative ERCP and sparing others the need for an endoscopic procedure with its associated complications.
Makary
Martin A
MA
Department of Surgery, Johns Hopkins University School of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. mmakary1@jhmi.edu
Duncan
Mark D
MD
Harmon
John W
JW
Freeswick
Paul D
PD
Bender
Jeffrey S
JS
Bohlman
Mark
M
Magnuson
Thomas H
TH
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002758:Cholangiography / Q000379:methods*; D002764:Cholecystitis / Q000000981:diagnostic imaging / Q000209:etiology; D041761:Cholecystolithiasis / Q000150:complications / Q000000981:diagnostic imaging; D002769:Cholelithiasis / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D042882:Gallstones / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology*; D011300:Preoperative Care / Q000379:methods; D016896:Treatment Outcome