Diagnostic Accuracy of MRCP as Compared to Ultrasound/CT in Patients with Obstructive Jaundice.
BACKGROUND
The expanding spectrum of therapeutic options for patients with surgical jaundice makes it necessary for the radiologist to precisely assess the etiology, location, level and extent of disease.


OBJECTIVE
To compare the diagnostic accuracy of Magnetic Resonance Cholangiopancreatography (MRCP) with Ultrasound and Computed Tomography (CT) in evaluation of patients with obstructive jaundice taking direct cholangiographies (ERCP and PTC), hystologic tests and anatomo-pathological findings after surgical intervention as gold standard.


METHODS
This prospective study included 50 patients who were referred to the radiology department with clinical features of biliary obstructive disease.


METHODS
Initial ultrasonography (USG) evaluation was followed by Computed tomography (CT) and Magnetic Resonance Cholangiopancreatography (MRCP);however in cases of benign pathologies where USG findings were unequivocal Computed tomography (CT )was not done to avoid unnecessary radiation exposure. The results were read by radiologists blinded to other imaging findings. The characteristic Endoscopic Retrograde Cholangiopancreatography (ERCP) features/ histopathological diagnosis / surgical findings (as applicable) were considered as final.


RESULTS
Diagnostic accuracy of MRCP (98%) in the diagnosis of benign and malignant diseases was relatively high (98% and 98%) as compared to CT (82.86% and 91.43% in benign and malignant respectively) and USG (88% and 88%). In the diagnosis of benign diseases MRCP was 100% sensitive compared to ultrasound (80.77%), which was more sensitive than CT scan (54.55%).In the diagnosis of malignant diseases, MRCP was more sensitive (95.83%) as compared to CT scan (91.67%), which was more sensitive than ultrasonography (79.17%).


CONCLUSIONS
Ultrasound as a screening modality is useful to confirm or exclude biliary dilatation and to choose patients for MRCP examination. MRCP is an important non invasive imaging investigation in the pre operative evaluation of patients with obstructive jaundice.
Assistant Professor, Department of Radiodiagnosis and Imaging, Sri Guru Ram Das Institute of Medical, Sciences and Research , Vallah, Sri Amritsar, India .
Amandeep
A
Singh
P. G. Resident, Department of Radiodiagnosis and Imaging, Sri Guru Ram Das Institute of Medical Sciences and Research , Sri Amritsar, India .
Harkaran Singh
HS
Mann
Professor and Head, Department of Radiodiagnosis and Imaging, Sri Guru Ram Das Institute of Medical, Sciences and Research , Vallah, Sri Amritsar, India .
Chuni Lal
CL
Thukral
Professor, Department of Surgery, Sri Guru Ram Das Institute of Medical Sciences and Research , Sri Amritsar, India .
Neeti Rajan
NR
Singh
CBD; Cholangiocarcinoma; Choledocholithiasis; MRCP; Obstructive jaundice; Periampullary carcinoma; Stricture