Magnetic resonance cholangio pancreatography in pancreaticobiliary surgical problems

ABSTRACT

Until recently, the non-invasive evaluation of patients suspected of having biliary tract lesions was limited to ultrasonognaphy [US] and computed tomography [CT], and inspite of their sensitivity in the detection of obstruction, we were in-need for direct cholangiography; especially endoscopic retrograde cholangiopancreatography [ERCP]; as standard of reference for visualizing the biliary tracts and pancreatic ducts for defining the cause and level of lesion. This study is constructed to evaluate Magnetic Resonance Cholangio-Pancreatography [MRCP] abilities in diagnosis of biliary tracts and pancreatic ducts lesions in comparison to the standard ERCP and surgery results. This study was held in MRJ Unit of Radiology Department, Tanta University; and Surgical Gastroenteniology Department of Al-Azhen University and Liven Research Center; during the period from January 2003 to June 2009. It included 37 patients; 29 [78.4%] male and 8 [21.6%] female; their age ranged from 23 to 78 years with median 48 +/- 3.1 years. U/S and MRCP examinations were performed for all patients in the study; while ERCP was done after two days in 32 patients. Surgery was done for 27 patients. MRCP was performed for all 37 patients in our study who were complaining of obstructive jaundice from different pathological causes with success nate [35 from 37] i.e. 94.6% ; ERCP was performed 48 hours after MRCP; in 32 patients only of our study cases; with success rate [29 from 32] i.e. 90.6% . Neoplastic cases were the majority in our study Thirteen cases carcinoma of head of pancrease, five cases cholangiocarcinoma two cases of gall bladder adenocarcinoma and one case of ampullary carcinoma We have one case of ductal papjllomatosis, seven cases of common bile duct [CBD] stones; five of them secondary to gall bladder stones, the other two cases followed cholecystectomy; five cases of postoperative iatrogenic common hepatic duct [CHD] ligation; two of them after open surgery and three after laparoscopic cholecystectomy; and lastly we had three cases of post-traumatic bile duct injuries. MRCP is an accurate means of diagnostic imaging of the biliary and pancreatic ducts safely and non-invasively, however it lacks therapeutic potential of ERCP which must be tooled as a necessary intenventional procedure after MRCP despite its drawbacks and high cost-effectiveness