J Korean Soc Radiol.  2018 Mar;78(3):147-156. 10.3348/jksr.2018.78.3.147.

Role of Magnetic Resonance Cholangiopancreatography in Evaluation of Choledocholithiasis in Patients with Suspected Cholecystitis

• You MW
• Jung YY
• Shin JY

• KMID: 2405716
• DOI: http://doi.org/10.3348/jksr.2018.78.3.147

Abstract

PURPOSE
To determine the role of magnetic resonance cholangiopancreatography (MRCP) in evaluation of choledocholithiasis in patients with suspected cholecystitis.
MATERIALS AND METHODS
A total of 78 patients (mean age: 66.06 ± 15.63 years; range: 21-94 years, Male:Female = 31:47) who had experienced symptoms of cholecystitis and who underwent computed tomography (CT), MRCP, and endoscopic retrograde cholangiopancreatography from January 2013 to February 2015 were included in this study. Two reviewers independently interpreted CT and MRCP images to determine the presence or absence of choledocholithiasis and cholelithiasis. Diagnostic performance (sensitivity, specificity, positive predictive value, negative predictive value, and accuracy) was compared between CT and MRCP. Interobserver agreement was also evaluated.
RESULTS
Forty-three patients underwent cholecystectomy. The accuracy of CT and MRCP for detection of gallbladder stones showed no significant difference. The sensitivity and accuracy of MRCP for detection of extrahepatic duct stones were superior to those of CT for both reviewers (reviewer 1: MRCP: sensitivity, 73.3%; accuracy, 76.9%; CT: sensitivity, 50%, accuracy 59%; p = 0.01; reviewer 2: MRCP: sensitivity, 75%; accuracy, 73.1%; CT: sensitivity, 50%; accuracy, 56.4%; p = 0.018). The interobserver agreement was consistent for both CT (k-value: 0.738) and MRCP (k-value: 0.701).
CONCLUSION
MRCP showed superior diagnostic performance for the detection of choledocholithiasis with reliable interobserver agreement. Considering the lack of radiation and contrast enhancement, MRCP would be an appropriate first-line modality in evaluation of common bile duct stones in patients with suspected cholecystitis.

MeSH Terms

Cholangiopancreatography, Endoscopic Retrograde
Cholangiopancreatography, Magnetic Resonance*
Cholecystectomy
Cholecystitis*
Choledocholithiasis*
Cholelithiasis
Common Bile Duct
Gallbladder
Humans
Multidetector Computed Tomography
Sensitivity and Specificity

Figure

• 

  Fig. 1. Flow chart of patient selection. Among 313 patients who underwent magnetic resonance cholangiopancreatography for suspected cholecystitis, 235 patients were excluded. Finally, total 78 patients were included in this study. CT = computed tomography, ERCP = endoscopic retrograde cholangiopancreatography, MRCP = magnetic resonance cholangiopancreatography

• 

  Fig. 2. A 91-year-old female patient, suspected with cholecystitis and true positive MRCP findings for choledocholithiasis. A, B. Subtle high-attenuating intraductal lesion in far distal CBD is detected retrospectively on unenhanced axial (A) and coronal (B) CT images (white arrows). Both reviewers interpreted CT as negative for CBD stone. C, D. Heavily T2-weighted TSE fat-saturated axial (C) and triggered 3-dimensional TSE MRCP (D) images reveal a visible distal CBD stone (white arrows), which was confirmed with endoscopic retrograde cholangiopancreatography. Both reviewers interpreted MRCP as positive for CBD stone. CBD = common bile duct, CT = computed tomography, MRCP = magnetic resonance cholangiopancreatography, TSE = turbo spin echo

• 

  Fig. 3. A 81-year-old male, suspected with cholecystitis and false positive MRCP findings of choledocholithiasis. A. Unenhanced axial computed tomography image shows no radiopaque bile duct stone in the extrahepatic duct (arrows). B, C. T2-weighted TSE axial (B) and triggered 3-dimensional TSE MRCP (C) images shows suspicious intraductal focal signal void in distal CBD (white arrows). Reviewer 2 interpreted MRCP as positive for biliary stone. Small periampullary diverticulum with air fluid level is seen next to distal CBD (arrow with dotted line). D. Heavily T2-weighted TSE fat-saturated axial image shows no intraductal signal void (arrows), indicating flow artifact rather than true CBD stones. Endoscopic retrograde cholangiopancreatography revealed no presence of CBD stones (not shown). CBD = common bile duct, MRCP = magnetic resonance cholangiopancreatography, TSE = turbo spin echo

• 

  Fig. 4. A 58-year-old male, suspected with cholecystitis and false negative MRCP findings for choledocholithiasis. A. Unenhanced axial CT image shows no radiopaque stone in the extrahepatic duct (arrow). B. Focal intraductal signal void in the distal CBD (arrow) is suspected on T2-weighted half-Fourier acquisition single-shot turbo spin-echo axial image. C, D. This lesion is not visible on other MRCP sequences such as heavily T2-weighted turbo spin-echo fat-saturated (C, arrow) and maximal intensity projection reconstruction (D) images. Both reviewers interpreted CT and MRCP images as negative for CBD stones. However, cholangiopancreatography revealed a CBD stone, which was removed (not shown). CBD = common bile duct, CT = computed tomography, MRCP = magnetic resonance cholangiopancreatography

Reference

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