Magnetic Resonance Cholangio-Pancreatography in Patients with Acute Cholecystitis and Cholestatic Liver Pattern - What to Expect?.

ABSTRACT

Acute cholecystitis is a potentially serious condition and usually needs to be treated in the hospital. Identification of a common bile duct (CBD) stone before cholecystectomy is of concern for the treating physicians as management may change. Magnetic Resonance Cholangiopancreatography (MRCP) can help in identifying causes of biliary obstruction (if present) and adequately delineate biliary tree in selected patients with limited or abnormal ultrasounds and cholestatic liver pattern. Therefore, we aim to demonstrate imaging findings of MRCP in such patients of acute cholecystitis, and highlight the diagnostic ability of MRCP in biliary ductal evaluation as well. METHODSThis secondary data analysis from hospital records was performed in Radiology department at our Hospital in Dhahran from August 2017 to 2019. All clinically suspected and ultrasound supported cases of acute cholecystitis who were referred for MRCP studies were included. Dilated CBDs (more than 4 mm in caliber) with partial visualization or non-discernible causes of CBD dilatations, rising or persistently raised LFTs (denoting cholestatic pattern) were the common indications for the MRCP referrals. Patients with chronic cholecystitis, previous hepatobiliary surgery, pregnant patients, and those contraindicated to MRI were excluded. RESULTSOf the 104 patients, majority (60%) were females. The mean age was 43 years. Two-thirds of patients were having normal CBDs (68.3%), while nearly one-third (31.7%) had dilated CBDs, and half of these (16.4%) showed identifiable causes of obstruction that were later confirmed on ERCP and histopathology. Thirteen patients (12.5%) had associated anomalies. Sensitivity and specificity of MRCP in CBD evaluation were measured as 90.5% (CI, 79.3-96.8) and 86.2% (CI, 73.7-94.3) respectively. The length of the hospital stay was found to be significantly less in laparoscopic cases compared to open cholecystectomies (P= 0.0005). CONCLUSIONSMagnetic resonance cholangiopancreatography can help in identifying the causes and anomalies in patients with acute cholecystitis having deranged or obstructive liver function.