ABSTRACT
PURPOSE: To prospectively compare MR cholangiopancreaticography (MRCP) vs. endoscopic retrograde pancreaticography (ERCP) in patients with suspected common bile duct (CBD) stone disease. MATERIAL AND METHODS: Fifty consecutive patients with suspected CBD disease underwent MRCP and then ERCP within 12 h of each other. The result of the MRCP was blinded to the reader of the ERCP. The MRCP was done using a superconducting 1.0 T unit with a heavily T2-weighted breath-hold technique. The ERCP was done in the fluoroscopy suite by one of the clinicians and was evaluated by one of the radiologists who had not read the MRCP examinations. RESULTS: There were 28 true-positives, 17 true-negatives, 1 false-positive, and 4 false-negatives. The sensitivity was 87.5% and the specificity 94.4%, respectively. The positive predictive value was 96.6% and the negative predictive value was 81.1%. CONCLUSION: MRCP was shown to be good enough to replace ERCP as a diagnostic method in patients with suspected CBD disease. MRCP is now our modality of choice after ultrasound in the diagnostic evaluation of these patients.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Gallstones/diagnosis , Magnetic Resonance Imaging/methods , Adult , Aged , Aged, 80 and over , False Negative Reactions , False Positive Reactions , Female , Fluoroscopy , Gallstones/diagnostic imaging , Humans , Image Enhancement , Image Processing, Computer-Assisted , Magnetic Resonance Imaging/instrumentation , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Sensitivity and Specificity , Single-Blind MethodABSTRACT
Magnetic resonance imaging of the biliary and pancreatic ducts, MRCP, is a technique developed over the last few years. Using strongly T2-weighted sequences, images of the biliary and pancreatic ducts similar to ERCP can be obtained within one single inhalation. No contrast media or medication is required. In 23 patients 25 MRCP examinations were retrospectively compared with ERCP or PTC. One patient had normal findings; three had gallbladder stones. Eight out of nine common bile-duct stones were shown. MRCP after papillotomy in one patient showed a common bile-duct stone; ERCP seven days later was normal. MRCP correctly showed obstruction and dilatation of the bileducts in ten patients with tumor and in one patient with chronic pancreatitis. Two of these were erroneously interpreted as caused by stone. 21 of 25 MRCPs were consistent with the final diagnosis. We consider MRCP a promising method which may replace diagnostic ERCP in majority of patients. Stones in the gallbladder and bile-ducts can be diagnosed. The method also shows obstructions and other lesions affecting pancreatobiliary ducts.
Subject(s)
Bile Duct Diseases/pathology , Bile Ducts/pathology , Magnetic Resonance Imaging , Pancreatic Diseases/pathology , Pancreatic Ducts/pathology , Adolescent , Adult , Aged , Bile Duct Diseases/diagnostic imaging , Bile Duct Neoplasms/diagnostic imaging , Bile Duct Neoplasms/pathology , Cholangiopancreatography, Endoscopic Retrograde , Cholelithiasis/diagnostic imaging , Cholelithiasis/pathology , Female , Gallstones/diagnostic imaging , Gallstones/pathology , Humans , Magnetic Resonance Imaging/methods , Male , Middle Aged , Pancreatic Diseases/diagnostic imaging , Pancreatic Ducts/diagnostic imaging , Pancreatic Neoplasms/diagnostic imaging , Pancreatic Neoplasms/pathology , Pancreatitis/diagnostic imaging , Pancreatitis/pathology , Retrospective StudiesABSTRACT
The intrasplenic pancreatic pseudocyst is very rare and surgical treatment has been recommended. We report on a patient with this condition who was successfully treated with percutaneous drainage. Special considerations apply when the drainage catheter is inserted intercostally.
