Comparative study between magnetic resonance cholangiopancreatography MRCP and surgical results in evaluation of obstructive jaundice

ABSTRACT

Thirty patients with obstructive jaundice suspected clinically, 14 males and 16 females were admitted in the surgery department, Assiut University Hospital, in the period between September 1999 to September 2000. Their ages ranging from 5 to 70 years. All patients were subjected to complete medical history, full clinical examination, biochemical study [liver function tests and hepatitis markers], abdominal US and MRCP. Twenty-three patients were operated upon. ERCP was done in three patients [as diagnostic, therapeutic and palliative], PTC and PTD [as diagnostic and palliative] was done in one patient. The last three patients were diagnosed by US and MRCP to have primary sclerosing cholangitis. MRCP images revealed surgical biliary obstruction in 27 cases with good quality images. It demonstrated the level of obstruction in all patients [27 cases were extrahepatic and 3 patients were intrahepatic] and diagnosed the causes of obstruction in 27 patients [13 cases were malignant, 7 were calcular, 3 primary sclerosing cholangitis, one benign stricture of common hepatic duct [CHD], one case benign stricture of common bile duct [CBD], one case stenosis of doudenal papilla and one case chronic pancreatitis]. In three patients there was distal obstruction of undetermined origin by MRCP. One patient had calcular obstructive jaundice by ERCP [false -ve] and in two patients no cause was found by surgical exploration. In this study, MRCP was found to be a helpful technique in children and also in malignant obstruction, where it enable to diagnose four early resectable cases [three with pancreatic head cancer and one patient with ampullary carcinoma]. The specificity of MRCP in this study was found to be 100%, the sensitivity 96%, the accuracy 96.5% and the success rate in diagnosis of biliary obstruction was 100%. It was concluded that, MRCP is evolving as a rapid, easy, accurate and noninvasive tool for evaluation of the pancreaticobiliary system in patients with various obstructing biliary conditions