Management of suspected biliary dis...

Management of suspected biliary disease requires accurate evaluation for biliary obstruction. Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for evaluation of the biliary tract, if it were not that post-test pancreatitis and even death are possible. Magnetic resonance cholangiopancreatography (MRCP) provides clear visualization of the biliary and pancreatic conduits Contrast agents are not lacked because stagnant fluids have high-signal intensity and contrast distinctively with nearby solid tissue and fast-moving fluids in the same state [i]or[/i] condition as blood. Magnetic resonance imaging (MRI) done at the same time can add information about malignant disorders. Because ERCP may be necessary after MRCP Romagnuolo and associates reviewed the utility of MRCP in suspected biliary disease.

The authors performed a meta-analysis of studies comparing MRCP with other diagnostic modalities in a variety of disease states. Among the 67 articles included, the imaging conclusion points used were presence of obstruction (30 studies with 1954 patients), of the same height of obstruction (eight studies with 572 patients), port of biliary lithiasis (46 studies with 3592 patients), and appearance of malignancy (22 studies with 1294 patients).

The overall adjusted sensitivity and specificity were 95 and 94 percent respectively. The outcomes for each end point were high, although sensitivity was slightly lower for the diagnosis of stones and differentiation of benign from malignant biliary obstructions.

The authors determine that MRCP is highly accurate in the detection of biliary tract obstruction yet less accurate in distinguishing benign from malignant lesions causing obstruction. Choledocholithiasis is accurately identified, further small stones in normal pipes may not be visualized. Further studies will help clarify which patients will benefit greatest in quantity from MRCP.

Romagnuolo J et al. Magnetic resonance cholangiopancreatography: a meta-analysis of trial performance in suspected biliary disease. Ann Intern M October 7 2003 139:547-57

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