title: Preoperative MRCP to detect choledocholithiasis in acute calculous cholecystitis.
abstract: OBJECTIVE
  There are risks of common bile duct (CBD) stones in acute cholecystitis, and there is a move among surgeons to identify choledocholithiasis before surgery. Magnetic resonance cholangiopancreaticography (MRCP) has the potential to accurately detect choledocholithiasis in patients with acute cholecystitis. The aim of this study was to evaluate the predictive values of MRCP and elevated biochemical predictors for choledocholithiasis in patients with acute cholecystitis.
  
  
  METHODS
  Between September 2006 and August 2008, of 84 patients with acute cholecystitis based on the diagnosis criteria of the Tokyo guidelines, 57 had MRCP preoperatively. The predictive values of six biochemical predictors for choledocholithiasis were also evaluated.
  
  
  RESULTS
  Of the 57 patients, seven (12.28%) had choledocholithiasis, of whom three had CBD stones in nondilated ducts. The smallest stone detected in a dilated CBD and nondilated duct was 3.19 and 4.55 mm in diameter, respectively. None of our patients whose MRCP showed a clear CBD returned with symptomatic choledocholithiasis during the follow-up period. All biochemical predictors and CBD diameter had limited positive predictive values.
  
  
  CONCLUSIONS
  Magnetic resonance cholangiopancreaticography is a reliable evaluation technique for the detection of choledocholithiasis. It reduces the misdiagnosis of retained choledocholithiasis with normal biochemical predictors and prevents the risk of overlooking choledocholithiasis. No single predictor or combined markers have been found to be reliable for including/excluding the presence of choledocholithiasis.
authors: Department of Surgery, Chung Shan Medical University Hospital, No.110, Chien-Kuo North Road, Section 1, Taichung 402, Taiwan. wdolphin@ms23.hinet.net
authors: Hon-Phin
authors: HP
authors: Wong
authors: Yu-Lun
authors: YL
authors: Chiu
authors: Bei-Hao
authors: BH
authors: Shiu
authors: Lu-Chang
authors: LC
authors: Ho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D049448:Cholangiopancreatography, Magnetic Resonance; D041881:Cholecystitis, Acute / Q000000981:diagnostic imaging / Q000453:epidemiology*; D041761:Cholecystolithiasis / Q000150:complications; D042883:Choledocholithiasis / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D003135:Common Bile Duct / Q000473:pathology; D015897:Comorbidity; D004108:Dilatation, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011379:Prognosis; D014463:Ultrasonography