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


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).


RESULTS
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.


CONCLUSIONS
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.
McMahon
Colm J
CJ
Department of Diagnostic Imaging, St. James Hospital, Dublin 8, Ireland, colmjmcmahon@yahoo.co.uk.
D001650:Bile Duct Neoplasms / Q000175:diagnosis*; D049448:Cholangiopancreatography, Magnetic Resonance; D002779:Cholestasis / Q000175:diagnosis*; D019160:Endosonography; D019317:Evidence-Based Medicine; D006801:Humans; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity