Value of serum bilirubin levels in selecting patients for magnetic resonance cholangiopancreatography.

BACKGROUND/AIMS: To determine the value of serum bilirubin levels in selecting patients for MRCP. METHODOLOGY: The medical records of 142 patients who underwent MRCP between January 2002 and December 2004 were retrospectively reviewed. Clinical features, serum bilirubin levels, and MRCP results were recorded. The patients were categorized into 4 groups, according to serum bilirubin levels and MRCP findings. Bilirubin levels were considered elevated above 23.9 micromol/L for total bilirubin and above 6.8 micromol/L for direct bilirubin. Sensitivity, specificity, accuracy, and predictive values of serum bilirubin levels in identifying pancreatobiliary duct diseases were assessed. RESULTS: Complete medical records were found for 135 patients. Abnormal MRCP results were found in 75 patients (56%). Choledocholithiasis and both malignant and benign bile duct strictures represented 40%, 28%, and 23% of abnormal MRCP findings, respectively, with mean values of total and direct serum bilirubin levels of 77.9 +/- 51.6 microM and 34.7 +/- 30.3 microM (for choledocholithiasis), 170 +/- 115 microM and 56 +/- 40 microM (for malignant bile duct stricture), and 44 +/- 32 microM and 20 +/- 16 microM (for benign bile duct stricture), respectively. Sensitivity, specificity, and accuracy of serum bilirubin level tests, for the diagnoses of pancreatobiliary duct diseases, were 77%, 80%, and 79%, respectively; the positive and negative predictive values were 83% and 74%, respectively, and the corresponding likelihood ratios were 3.8 and 0.3. CONCLUSIONS: Serum bilirubin level tests alone are not sufficiently accurate for the diagnoses of pancreatobiliary duct diseases, and hence, such tests are of low importance in selecting patients for MRCP.

Magnetic resonance imaging of normal lumbar intervertebral foraminal height.

OBJECTIVE: To study the pattern and changes of lumbar intervertebral foraminal heights in an asymptomatic Jordanian sample relative to age, sex, level, and correlate values with midpoint vertebral and disc heights. METHODS: One hundred and fifty-three patients (87 male and 66 female) were selected during the study period. The study was carried out at the Jordan University Hospital, Amman, Jordan from June 1999 to June 2000. Parasagittal magnetic resonance images were used to measure intervertebral foraminal heights at all lumbar levels. Values were statistically analyzed and the significance of differences in the means of foraminal heights at different levels in every age group and among age groups was determined. Foraminal height indices and correlation coefficients with midpoint vertebral and disc heights were calculated. RESULTS: The study revealed that the mean foraminal height measured is 20.9 mm 1.7 with a range of 17.1-24 mm. Foraminal heights increased significantly in a craniocaudal pattern reaching a maximum at lumber (L)2/3 in females and at L3/4 in males followed by continuous significant decrease reaching their minimum at L5/sacral (S) 1. In relation to age, foraminal heights decreased significantly in females reaching their minimum in the 7th decade. In males, foraminal heights at L3/4 until L5/S1 increased significantly reaching their maximum in the 5th decade followed by significant decrease reaching their minimum in the 7th decade. Foraminal height indices remained relatively constant. A fair degree of correlation of foraminal heights with intervertebral disc heights and vertebral body heights was evident. CONCLUSION: Foraminal heights show different level and age-dependent characteristic pattern of change between asymptomatic males and females. Changes of foraminal heights seem to directly reflect changes of vertebral body heights. These changes are considered normal age-dependent changes, and are discussed under consideration of adaptation to physical activity and changing hormonal levels.

Magnetic resonance imaging of normal lumbar intervertebral foraminal height.

OBJECTIVE: To study the pattern and changes of lumbar intervertebral foraminal heights in an asymptomatic Jordanian sample relative to age, sex, level, and correlate values with midpoint vertebral and disc heights. METHODS: One hundred and fifty-three patients (87 male and 66 female) were selected during the study period. The study was carried out at the Jordan University Hospital, Amman, Jordan from June 1999 to June 2000. Parasagittal magnetic resonance images were used to measure intervertebral foraminal heights at all lumbar levels. Values were statistically analyzed and the significance of differences in the means of foraminal heights at different levels in every age group and among age groups was determined. Foraminal height indices and correlation coefficients with midpoint vertebral and disc heights were calculated. RESULTS: The study revealed that the mean foraminal height measured is 20.9 mm +/-1.7 with a range of 17.1-24 mm. Foraminal heights increased significantly in a craniocaudal pattern reaching a maximum at lumber (L)2/3 in females and at L3/4 in males followed by continuous significant decrease reaching their minimum at L5/sacral (S) 1. In relation to age, foraminal heights decreased significantly in females reaching their minimum in the 7th decade. In males, foraminal heights at L3/4 until L5/S1 increased significantly reaching their maximum in the 5th decade followed by significant decrease reaching their minimum in the 7th decade. Foraminal height indices remained relatively constant. A fair degree of correlation of foraminal heights with intervertebral disc heights and vertebral body heights was evident. CONCLUSION: Foraminal heights show different level- and age-dependent characteristic pattern of change between asymptomatic males and females. Changes of foraminal heights seem to directly reflect changes of vertebral body heights. These changes are considered normal age-dependent changes, and are discussed under consideration of adaptation to physical activity and changing hormonal levels.