Importance of MRCP in evaluation of pancreatobiliary diseases

 

 

Abstract              Background: To determine importance of MRCP in screening and diagnosis of pancreaticobiliary disease. MRCP was performed in 50 patients attending our gastroenterlogy OPD using GE 1.5T MRI Findings were confirmed by follow-up surgery, biopsy, histopathology. Materials and Methods: The study was conducted in the Department of Radiology, BGS Global Institute of Medical Sciences, Bengaluru, Karnataka. After obtaining the Informed consent from all the study subjects, a total of 50 patients with clinically suspected choledocholithiasis and sonological evidence of pancreatico-biliary obstruction were recruited for this study. Age of the study subjects ranged from 20 to ≥ 60 years and both sexes were included in this study suffering from common bile duct and pancreatic pathologies. After the diagnosis of bile duct/pancreatic pathologies by laboratory investigations and USG of abdomen and pelvis, MRCP was done. Results: In the present study, a total of 50 patients suffering with various pancreaticobiliary pathologies were studied. In this study, 24 (48%) patients were belongs to ≥ 51 years of age group, 15 (30%) were in the 41-50 years of age group, 8 (16%) were in 31-40 years and 3 (6%) were in 20-30 years of age group. In this study, 10 (20%) patients were diagnosed to have Cholangiocarcinoma, 8 (16%) patients with gall bladder carcinoma, 10 (20%) patient with choledhocal cyst, 10 (20%) patients presented with stricture, 4 (8%) patients had cholelithiasis, 3 (6%) patients had chronic pancreatitis, 1 (2%) had acute pancreatitis, 1 (2%) had emphysematous cholecystitis and 2 (4%) had IHBRD dilatation due to obstruction by portal lymph node. In one (2%) patient MRCP was normal. Conclusion: MRI serves as an accurate and non invasive imaging method for evaluation of pancreatico-biliary anatomy and pathology. Combination of MRI and MRCP allows safe surgical management decision. Potentially useful in patients undergoing biliary enteric anastomosis for knowing the level and extent of strictures.

Keywords: MRCP, Pancreatobiliary, Stricture

 

INTRODUCTION

Magnetic Resonance Cholangio Pancreatography (MRCP) is a useful technique in the diagnosis of disorders of pancreatico-billiary systems such as Cholelithiasis, Choledocholithiasis, acute cholecystitis, chronic cholecystitis, CBD strictures, acute and chronic pancreatitis, and also pseuodcyst of pancreas. It is also useful in the diagnosis of gall bladder carcinoma, cholangitis, cholangiocarcinoma etc.¹ For the evaluation of biliary obstruction, variety of imaging modalities are available including ultrasonography (US), computed tomography (CT) and invasive cholangiography. These techniques are limited with poor visualization of intraductal calculi on ultrasound and CT studies along with the need for invasive procedures like ERCP and PTC. ² But, MRCP is a non-invasive imaging technique, which provides good visualization of the biliary system. Ultrasound followed by CT scan are the screening tool that is useful in evaluating patients presenting with pancreatic biliary diseases.³ However, ultrasonography has been used for many years, it has limitations especially in the evaluation of the distal CBD where bowel gas, debris, fluid in the duodenum and obesity can interfere with the image quality. In addition to this, CT scan also has its own limitations, especially in biliary stones and biliary strictures. Therefore, limitations of US and CT and invasiveness of PTC, IVC and ERCP there is need for an imaging modality which is non invasive and provides high resolution projection images of the biliary and pancreatic duct.² Therefore, the development of higher magnetic field strength and newer pulse sequences, the MRCP technique uses heavily T2-weighted imaging, which produces high signal from bile and other static fluids by virtue of their long T2 time, while suppressing background signal. Fast scanning techniques, particularly half-Fourier fast spin-echo techniques, are continuing to improve image resolution and allow scans within short breath-holds, reducing the effects of respiratory movement. ³ A few studies demonstrated that MRCP is able to accurately identify common bile duct stones with sensitivity of 81-100 %. Biliary strictures can also be visualized with sufficient anatomic detail to determine the level of obstruction and in some instances, differentiate benign from malignant causes.^2,4 In addition, MRCP lacks the major complication rate of approximately 3% associated with ERCP such as sepsis, bleeding, bile leak and death. MRCP demonstrates more than just the biliary and pancreatic ducts. Its disadvantages include lack of visualization of the peripheral intrahepatic ducts and inability to provide endobiliary therapy. ⁴ Therefore, the present study is aimed to detect various pancreaticobiliary pathologies and to evaluate role of MRCP in various pancreaticobiliary pathologies.

 

MATERIALS AND METHODS

The study was conducted in the Department of Radiology, BGS Global Institute of Medical Sciences, Bengaluru, Karnataka. After obtaining the Informed consent from all the study subjects, a total of 50 patients with clinically suspected choledocholithiasis and sonological evidence of pancreatico-biliary obstruction were recruited for this study. Age of the study subjects ranged from 20 to ≥ 60 years and both sexes were included in this study suffering from common bile duct and pancreatic pathologies. However, patients with congenital abnormalities, metallic implants, cardiac pacemaker, cochlear implant were excluded from the study. All the patients underwent MRCP (HASTE coronal and axial, T1 weighted axial, MRCP using heavily T2 weighted sequences) in Siemens 1.5 Tesla Magnetom Avanto. After the diagnosis of bile duct/pancreatic pathologies by laboratory investigations and USG of abdomen and pelvis, MRCP was done. Furthermore, based on MRCP findings the patients were subjected to either endoscopic/surgical procedure and/or medical treatment.

Machine: GE Signa HDxT Twinspeed 1.5 T MRI (USA).

Coil: Body coil.

FOV: 20x30 cm.

Matrix: 256 x 256, 352x352.

 

RESULTS

In the present study, a total of 50 patients suffering with various pancreaticobiliary pathologies were studied to evaluate role of MRCP significance in evaluating these disease pathophysiologies. In this study, 24 (48%) patients were belongs to ≥ 51 years of age group, 15 (30%) were in the 41-50 years of age group, 8 (16%) were in 31-40 years and 3 (6%) were in 20-30 years of age group (Table 1). In this study, 10 (20%) patients were diagnosed to have Cholangiocarcinoma, 8 (16%) patients with gall bladder carcinoma, 10 (20%) patients with choledhocal cyst, 10 (20%) patients presented with stricture, 4 (8%) patients had cholelithiasis, 3 (6%) patients had chronic pancreatitis, 1 (2%) had acute pancreatitis, 1 (2%) had emphysematous cholecystitis and 2 (4%) had IHBRD dilatation due to obstruction by portal lymph node. In one (2%) patient MRCP was normal (Table 2).

 

 

 

 

 

 

 

 

Height, IVDL-Intervertebral Disc Length