Original Research

The role of magnetic resonance cholangiopancreatography and diffusion-weighted imaging for the differential diagnosis of obstructive biliary disorders

Zeynep Cetiner-Alpay, Fatma Kulali, Aslihan Semiz-Oysu, Yasar Bukte, Kamil Ozdil
South African Journal of Radiology | Vol 21, No 1 | a1193 | DOI: https://doi.org/10.4102/sajr.v21i1.1193 | © 2017 Zeynep Cetiner-Alpay, Fatma Kulali, Aslihan Semiz-Oysu, Yasar Bukte, Kamil Ozdil | This work is licensed under CC Attribution 4.0
Submitted: 08 March 2017 | Published: 28 June 2017

About the author(s)

Zeynep Cetiner-Alpay, Department of Radiology, Ordu University Training and Research Hospital, Turkey
Fatma Kulali, Department of Radiology, Health Sciences University, Umraniye Training and Research Hospital, Turkey
Aslihan Semiz-Oysu, Department of Radiology, Health Sciences University, Umraniye Training and Research Hospital, Turkey
Yasar Bukte, Department of Radiology, Health Sciences University, Umraniye Training and Research Hospital, Turkey
Kamil Ozdil, Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Turkey


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Abstract

Background: Although endoscopic retrograde cholangiopancreatography (ERCP) is accepted as the gold standard, there is a place for magnetic resonance cholangiopancreatography (MRCP) and diffusion-weighted imaging (DWI) in the diagnosis of obstructive biliary disorders.

Aim: To compare the findings of MRCP with ERCP in patients with obstructive biliary disorders and to investigate the diagnostic efficacy of MRCP combined with DWI.

Study design: Retrospective, analytic, cross-sectional study.

Methods: The MRCP images of 126 patients who underwent both MRCP and ERCP owing to biliary obstruction were reviewed. Nine patients were excluded because of incomplete diagnostic workup or a long period (>3 months) between MRCP and ERCP. Ninety-two patients underwent DWI, which was also evaluated. The sensitivity, specificity and accuracy of MRCP and DWI were analysed.

Results: The sensitivity, specificity and accuracy of MRCP according to ERCP results as the gold standard was 97%, 71% and 93% for assessment of biliary dilatation; 100%, 94.7% and 97.5% for the diagnosis of choledocholithiasis; 93.7%, 100% and 99% for the identification of benign strictures; 100%, 100% and 100% for the diagnosis of malignant tumours; and 100%, 100% and 100% for the detection of complicated hydatid cysts; respectively. The sensitivity and specificity of DWI for the diagnosis of malignant tumour was 100%. In the detection of choledocholithiasis, the sensitivity and specificity of DWI was 70.8% and 100%.

Conclusions: MRCP is an alternative, non-invasive, diagnostic modality, comparable with ERCP for the evaluation of pancreaticobiliary diseases. DWI can be helpful for diagnosis of choledocholithiasis and tumours.


Keywords

choledocholithiasis; diffusion weighted imaging; endoscopic retrograde cholangiopancreatography; magnetic resonance cholangiopancreatography; pancreaticobiliary disease

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