Role of Combined CT and MRCP in the Pre-Operative Assessment of Obstructive Biliopathy: An Observational Study, in a Tertiary Care Hospital
Authors/Creators
- 1. Assistant Professor, Department of General Surgery, Agartala Govt. Medical College & GBPH; Agartala, Tripura
- 2. Assistant Professor, Department of Urology, Agartala Govt. Medical College & GBPH; Agartala, Tripura
Description
Obstructive jaundice is a prevalent hepatobiliary disease causing high morbidity and mortality. Despite advancements in diagnosis, management, and treatment, it remains a significant issue. Radiologists must assess the disease’s etiology, location, and extent before deciding on treatment. Ultrasound (US) is the primary technique for studying biliary obstructive diseases due to its accessibility, speed, and low cost. Traditional Computed Tomography (CT) is considered more accurate for determining obstruction causes. Magnetic Resonance Imaging with Magnetic Resonance Cholangiopancreatography (MRI with MRCP) is emerging as an exciting tool for noninvasive evaluation of patients with obstructive jaundice. This study investigates the use of MRI with MRCP for evaluating biliary duct systems, specifically in cases of cholangiocarcinoma or distal common duct obstruction. Methods: The study investigates the use of combined CT and MRCP in preoperative assessment of obstructive biliopathy, aiming to diagnose the condition using CT and MRCP and confirm their diagnostic accuracy with intraoperative findings. The observational study was conducted in collaboration with the Department of Surgery at AGMC and GBP Hospital, spanning one and a half years from January 2018 to June 2019. The sample size was 25 patients with obstructive jaundice, including those with clinical features, biochemical features, dilatation of the biliary system, clinically documented cause, and surgical or obstructive lesion. Patients under 12 years, those with prehepatic/hepatic jaundice, patients who refused to give consent, and those with contraindications for MRCP were excluded. The study was conducted with prior approval from the Ethical Committee of AGMC & GBPH Agartala, Tripura. Discussion: The study by Kushwah A et al (2015) found that obstructive biliary disease (OBD) is a common issue, with jaundice being the most common symptom. USG was the first choice for diagnosing obstructive biliary disease, with a sensitivity of 81.2%. The study also found that choledocholithiasis was the most common benign cause. MRCP was found to be more accurate and invasive than USG in diagnosing both benign and malignant diseases. MRCP has a high diagnostic accuracy of 98%, making it a new gold standard for diagnosing CBD and pancreatic ductal pathologies. It is recommended for preoperative diagnosis of gallstones, as it can rule out possible concomitant CBD stones. MRCP can also detect residual or iterative choledocholithiasis in patients post-cholecystectomy, potentially replacing endoscopic retrograde cholangiopancreatography (ERCP) and reducing unnecessary invasive procedures. The study highlights the importance of identifying obstructive and non-obstructive causes in diagnosing biliary disorders. Conclusion: Radiologists play a crucial role in selecting appropriate imaging for patient management, with ultrasound being useful for diagnosing biliary obstruction but not for obstructive jaundice. Non-invasive MRCP, with higher diagnostic accuracy, is essential for preoperative evaluation and treatment planning.
Abstract (English)
Obstructive jaundice is a prevalent hepatobiliary disease causing high morbidity and mortality. Despite advancements in diagnosis, management, and treatment, it remains a significant issue. Radiologists must assess the disease’s etiology, location, and extent before deciding on treatment. Ultrasound (US) is the primary technique for studying biliary obstructive diseases due to its accessibility, speed, and low cost. Traditional Computed Tomography (CT) is considered more accurate for determining obstruction causes. Magnetic Resonance Imaging with Magnetic Resonance Cholangiopancreatography (MRI with MRCP) is emerging as an exciting tool for noninvasive evaluation of patients with obstructive jaundice. This study investigates the use of MRI with MRCP for evaluating biliary duct systems, specifically in cases of cholangiocarcinoma or distal common duct obstruction. Methods: The study investigates the use of combined CT and MRCP in preoperative assessment of obstructive biliopathy, aiming to diagnose the condition using CT and MRCP and confirm their diagnostic accuracy with intraoperative findings. The observational study was conducted in collaboration with the Department of Surgery at AGMC and GBP Hospital, spanning one and a half years from January 2018 to June 2019. The sample size was 25 patients with obstructive jaundice, including those with clinical features, biochemical features, dilatation of the biliary system, clinically documented cause, and surgical or obstructive lesion. Patients under 12 years, those with prehepatic/hepatic jaundice, patients who refused to give consent, and those with contraindications for MRCP were excluded. The study was conducted with prior approval from the Ethical Committee of AGMC & GBPH Agartala, Tripura. Discussion: The study by Kushwah A et al (2015) found that obstructive biliary disease (OBD) is a common issue, with jaundice being the most common symptom. USG was the first choice for diagnosing obstructive biliary disease, with a sensitivity of 81.2%. The study also found that choledocholithiasis was the most common benign cause. MRCP was found to be more accurate and invasive than USG in diagnosing both benign and malignant diseases. MRCP has a high diagnostic accuracy of 98%, making it a new gold standard for diagnosing CBD and pancreatic ductal pathologies. It is recommended for preoperative diagnosis of gallstones, as it can rule out possible concomitant CBD stones. MRCP can also detect residual or iterative choledocholithiasis in patients post-cholecystectomy, potentially replacing endoscopic retrograde cholangiopancreatography (ERCP) and reducing unnecessary invasive procedures. The study highlights the importance of identifying obstructive and non-obstructive causes in diagnosing biliary disorders. Conclusion: Radiologists play a crucial role in selecting appropriate imaging for patient management, with ultrasound being useful for diagnosing biliary obstruction but not for obstructive jaundice. Non-invasive MRCP, with higher diagnostic accuracy, is essential for preoperative evaluation and treatment planning.
Files
IJPCR,Vol16,Issue2,Article139.pdf
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Additional details
Dates
- Accepted
-
2024-01-26
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/16/IJPCR,Vol16,Issue2,Article139.pdf
- Development Status
- Active
References
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