title: The utility of magnetic resonance cholangiopancreatography for the assessment of patients with elevated liver enzyme levels.
abstract: OBJECTIVE
  To evaluate the usefulness of magnetic resonance cholangiopancreatography (MRCP) in patients referred for assessment of the cause of elevated liver enzymes.
  
  
  METHODS
  The MRCP scans of 170 patients between 2009 and 2011 with elevated liver enzyme levels were blindly and independently rereviewed by two experienced radiologists. Biochemical data were collected from the medical records. Receiver operating characteristics curve analyses were carried out. Cutoff levels of the enzymes to predict pathological MRCPs were determined by the area under the curve (AUC). Sensitivity, specificity, negative predictive value, and positive predictive value were calculated.
  
  
  RESULTS
  MRCP scans of 134 patients were identically diagnosed by the two reviewers as nonpathological and 22 as pathological and 14 as uncertain. The agreement between the two reviewers was κ=0.62, indicating good agreement. The percentage of pathological MRCP performed because of elevated liver enzymes was only 14%. For patients with inflammatory bowel disease, the frequency was 36%. On receiver operating characteristics curve analysis, Az values were high for alkaline phosphatase 160 U/l (AUC=0.725) and γ-glutamyl transferase 270 U/l (AUC=0.617). Alkaline phosphatase and γ-glutamyl transferase had a high negative, but low positive predictive value for distinguishing pathological from normal scans.
  
  
  CONCLUSIONS
  MRCP does not contribute markedly toward the evaluation of the cause of elevated enzyme levels, except in patients with inflammatory bowel disease. These findings can provide practical guidelines for evaluation of patients with abnormal liver enzymes and for alleviation of the financial burden from health providers.
authors.affiliation: Department of Radiology, Rabin Medical Center, Beilinson Campus, Israel.
authors.forename: Ofer
authors.initials: O
authors.lastname: Benjaminov
authors.forename: Gil N
authors.initials: GN
authors.lastname: Bachar
authors.forename: Natalia
authors.initials: N
authors.lastname: Goldberg
authors.forename: Fabiana
authors.initials: F
authors.lastname: Benjaminov-Sclarovsky
authors.forename: Ran
authors.initials: R
authors.lastname: Tur-Kaspa
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001649:Bile Duct Diseases / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D049448:Cholangiopancreatography, Magnetic Resonance / Q000379:methods*; D004796:Clinical Enzyme Tests / Q000379:methods; D003430:Cross-Sectional Studies; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis; D008099:Liver / Q000201:enzymology*; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D055815:Young Adult; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D015415:Biomarkers; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase