Choledocholithiasis: MRCP versus endoscopic US

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Choledocholithiasis: repetitive thick-slab single-shot

projection magnetic resonance cholangiopancreaticography

versus endoscopic ultrasonography

Authors:

Schmidt, S.; Chevallier,

P.; Novellas, S.; Gelsi, E.; Vanbiervliet, G.; Tran, A.; Schnyder,

P.; Bruneton, J.

Source: European Radiology,

Volume 17, Number 1, January 2007

Abstract:

This

prospective study compares repetitive thick-slab single-shot projection

magnetic resonance cholangiopancreatography (MRCP)

with endoscopic ultrasonography

(EUS) for the detection of choledocholithiasis. Fifty-seven consecutive patients (36 women, mean age 61)

referred for suspected choledocholithiasis underwent

MRCP, followed by EUS. Each procedure was performed by

different operators blinded to the results of the other investigation. MR technique included a turbo spin-echo T2-weighted axial sequence

with selective fat saturation (SPIR/TSE, TE=70 ms, TR=1,600 ms), followed by

coronal dynamic MRCP. The same thick-slab slice was

sequentially acquired 12 times as breath-hold single-shot projection imaging (SSh, TE=900 ms, TE=8,000 ms) centred

on the common bile duct (CBD). Two experienced

radiologists independently and blindly evaluated MR images for the detection of

CBD stones. Their inter-observer agreement kappa was

determined. Secondly, the two observers read MR images

in consensus again. CBD stones were demonstrated in 18

out of 57 patients (31.6 %) and confirmed by endoscopic

retrograde cholangiography (ERCP, n=17) or intraoperative

cholangiography (n=1). Clinical follow-up served as the “gold

standard” in patients with negative results without following invasive

procedure (n=28). Sensitivity, specificity, accuracy, positive and negative

predictive value for MRCP resulting from consensus reading were 94.9%, 94.4%,

94.7%, 97.4% and 89.5%, respectively. Corresponding

values of EUS were 97.4%, 94.4%, 96.5%, 97.4% and 94.4%. Inter-observer

agreement kappa was 0.81. Repetitive thick-slab

single-shot projection MRCP is an accurate non-invasive imaging modality for

suspected choledocholithiasis and should be

increasingly used to select those patients who require a subsequent therapeutic

procedure, namely ERCP.

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