Comparing the efficacy of preoperative magnetic resonance cholangiopancreatography with intra-operative cholangiography in patients suspicious to biliary stones.
OBJECTIVE
This study was performed to compare the efficacy of preoperative magnetic resonance cholangiopancreatography (MRCP) and intra-operative cholangiography (IOC) methods in patients suspicious to gall stones.


BACKGROUND
According to previous studies, it is recommended that common bile duct investigation should be done in order to rule out choledocholithiasis in all patients with symptomatic cholelithiasis. IOC is an invasive procedure with probable complications, it would seem that MRCP could replace the direct cholangiography.


METHODS
In a diagnostic clinical trial, Fifty-nine patients with symptomatic biliary stones or cholecystitis were recruited in this study. The included patients had normal size biliary ducts in sonography but high serum alkaline phosphatase level. Preoperative MRCP and IOC were performed for the patients and the obtained results were analyzed and compared.


RESULTS
The positive predictive value for IOC was 88% and for MRCP was 43%. The diagnostic accuracy of IOC and MRCP were 98% and 85% respectively, suggesting that IOC is much more diagnostically accurate. There were no significant difference in specificity and sensitivity of these two methods.


CONCLUSIONS
According to the results, we can conclude that MRCP may not obviate the need for IOC. The suggestion for routine use of MRCP instead of IOC and as a substitution of that procedure needs further investigations on more patients.
Department of Surgery, Imam Hossein Medical Center, Shahid Beheshi University of Medical Sciences, Tehran, Iran.
Arash Mohammadi
AM
Tofigh
Department of Surgery, Imam Hossein Medical Center, Shahid Beheshi University of Medical Sciences, Tehran, Iran.
Forough
F
Razmjoie
Department of Surgery, Imam Hossein Medical Center, Shahid Beheshi University of Medical Sciences, Tehran, Iran.
Alieh
A
Khabbaz
Department of Surgery, Imam Hossein Medical Center, Shahid Beheshi University of Medical Sciences, Tehran, Iran.
Khosro
K
Ayazi
Department of Surgery, Imam Hossein Medical Center, Shahid Beheshi University of Medical Sciences, Tehran, Iran.
Siamak
S
Farahmand
Department of Surgery, Imam Hossein Medical Center, Shahid Beheshi University of Medical Sciences, Tehran, Iran.
Behzad Nemati
BN
Honar
Department of Surgery, Imam Hossein Medical Center, Shahid Beheshi University of Medical Sciences, Tehran, Iran.
Mohammad Reza
MR
Nikshoar
Alkaline phosphatase; Cholecystitis; Gall stone; Intra-operative cholangiography; Magnetic resonance cholangiopancreatography