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The study of role of magnetic resonance cholangio-pancreatography (MRCP) in pancreato-biliary disorders

Nehal Diwanji, Rajeev B Dibbad, Mona Sastri, Ekta Desai.

Abstract
Background: Evaluation of suspected biliary obstruction has traditionally involved a variety of imaging modalities including ultrasonography (US), computed tomography (CT), and invasive cholangiography. These techniques have limitations because of poor visualization of intra-ductal stones on US and CT and the need for invasive procedures like endoscopic retrograde cholangio-pancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC). Magnetic resonance cholangio-pancreatography (MRCP) is a non-invasive imaging modality that provides good visualization of the hepato-biliary system.

Objective: To describe the MRCP appearance of pancreatico-biliary diseases and differentiating benign from malignant strictures, and also to determine sensitivity, specificity, and accuracy of MRCP in the detection of pancreatico-biliary diseases.

Materials and Methods: A prospective study carried out over a period of 2 years. If on ultrasonography patient having pancretico–biliary disease then s/he would be selected for the study. Once the patient agrees to participate in the study, information is obtained as per the performa. MRCP was done in all participants.

Result: The peak incidence of pancreatico-biliary diseases is seen in the age group of 61–70 years with 9 (22.5%) participants. Common presenting complaint were right upper quadrant pain seen in 37 (92.5%) patients followed by yellowish discoloration of skin and sclera, present in 29 (32.5%) of patients. The cases of cholangiocarcinoma predominated and was seen in 08 (20 %) patients followed by choledochal cyst in 06 (15 %) and cholelithiasis-choledocholithiasis in 6 (15%). Benign diseases were seen in 21 (52.5%) participants while malignant diseases in 19 (47.5%). Sensitivity and specificity of MR pancreatico-cholengiography scan for pancreatico-biliary diseases was nearly 95%. Also accuracy of diagnosis was also 95%.

Conclusion: MRCP is providing useful criteria in differentiating benign from malignant strictures. MRI in combination with MRCP has the advantage of multiplanar capability, high tissue contrast, combining projectional, and cross sectional images in the evaluation of the biliary system. After the initial USG examination in these patients, the next investigation should be MRI with MRCP.

Key words: Pancreatico-biliary diseases, magnetic resonance cholangio-pancreatography (MRCP)


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