Background: Biliary system imaging can be done invasively (Ultrasonography, Computed Tomography) or noninvasively (Endoscopic Retrograde Cholangio Pancreatography). Currently we opt for non invasive Magnetic Resonance Cholangio-Pancreatography [MRCP] to detect biliary pathologies accurately.

MRCP is noninvasive with inherent high contrast resolution, multi planar acquisition capability and with avoidance of contrast and ionizing radiation; is able to create projectional type images. It can also reveal extraductal tumours and is unaffected by bowel gas giving high resolution images with better sensitivity.

Aim:

1. To evaluate patients with clinical suspicion of pancreato – biliary ductal pathologies with conventional Magnetic Resonance Imaging (MRI) and Magnetic Resonance Cholangio-Pancreatography (MRCP).
2. To compare the diagnostic accuracy of MRCP with Ultrasonography (USG) for the evaluation of pancreato – biliary ductal diseases.

Materials and Methods: The study comprised of a total no of hundred cases suffering from various pancreato – biliary ductal diseases of all age groups and either sex in the previous 18 months who were referred to Radiology department, KIMS, Amalapuram.

Results: In our study, we found that USG has 95.45% accuracy in diagnosing benign and malignant pancreato-biliary pathologies while MRCP is 97% accurate when compared to the standard histopathology.

Conclusion: Based on our study, we conclude that MRI serves as an accurate and non-invasive, nonionizing imaging method for evaluation of biliary anatomy and pathology; and can be considered as the gold standard for evaluating pancreato-biliary pathologies compared to USG.

Keywords: MRI, Magnetic Resonance Cholangio-Pancreatography (MRCP), ultrasonography (USG), pancreato-biliary pathologies.

1. Dawson P, Adam A, Benjamin I S .Intravenous Cholangiography revisited. Clinical Radiology 1993; 47:223-225.
2. Patel JC, Mc-Innes GC, Bagley JS, Needham G, Krukowski ZH. The role of intravenous cholangiography in pre-operative assessment for laparoscopic cholecystectomy. The British journal of radiology. 1993 Dec;66(792):1125-7.
3. Wallner BK, Schumacher KA, Weidenmaier W, Friedrich JM. Dilated biliary tract: evaluation with MR cholangiography with a T2-weighted contrast-enhanced fast sequence. Radiology. 1991 Dec;181(3):805-8..
4. Schwartz LH, Coakley FV, Sun Y, Blumgart LH, Fong Y, Panicek DM. Neoplastic pancreaticobiliary duct obstruction: evaluation with breath-hold MR cholangiopancreatography. AJR. American journal of roentgenology. 1998 Jun;170(6):1491-5
5. Soto JA, Barish MA, Yucel EK, Siegenberg D, Ferrucci JT, Chuttani R. Magnetic resonance cholangiography: comparison with endoscopic retrograde cholangiopan-creatography. Gastroenterology. 1996 Feb 1;110(2):589-97.
6. Larena JA, Astigarraga E, Saralegui I, Merino A, Capelastegui A, Calvo MM. Magnetic resonance cholangiopancre-atography in the evaluation of pancreatic duct pathology. The British journal of radiology. 1998 Oct;71(850):1100-4.
7. James E Pearls .Advanced MRI - From Head to Toe. 2002; 3:211-246.
8. Takehara Y. Fast MR imaging for evaluating the pancreaticobiliary system. European journal of radiology. 1999 Mar 1;29(3):211-32.
9. Nirhale DS, Kulkarni GC, Shingade P, Chavan S, Sonawane T, Dhende M. Role of magnetic resonance cholangiopanc-reatography in diagnosing pancreatobiliary pathologies: a prospective study. International Surgery Journal. 2018 May 24;5(6):2233-7.
10. Norero E, Norero B, Huete A, Pimentel F, Cruz F, Ibanez L, Martinez J, Jarufe N. Accuracy of magnetic resonance cholangiopancreatography for the diagnosis of common bile duct stones. Revistamedica de Chile. 2008 May;136(5):600-5.
11. Romagnuolo J, Bardou M, Rahme E, Joseph L, Reinhold C, Barkun AN. Magnetic resonance cholangiopancreato-graphy: a meta-analysis of test performance in suspected biliary disease. Annals of internal medicine. 2003 Oct 7;139(7):547-57.
12. Gautier G, Pilleul F, Crombe-Ternamian A, Gruner L, Ponchon T, Barth X, Valette PJ. Contribution of magnetic resonance cholangiopancreatography to the management of patients with suspected common bile duct stones. Gastroentérologie Clinique et biologique. 2004 Feb 1;28(2):129-34.
13. Bhatt C, Shah PS, Prajapati HJ, Modi J. Comparison of diagnostic accuracy between USG and MRCP in biliary and pancreatic pathology. Indian Journal of Radiology and Imaging. 2005 May 1;15(2):177.
14. Håkansson K, Leander P, Ekberg O, Håkansson HO. MR imaging in clinically suspected acute cholecystitis: a comparison with ultrasonography. Actaradiologica. 2000 Jul;41(4):322-8.
15. Rana SS, Chaudhary V, Sharma R, Sharma V, Chhabra P, Bhasin DK. Comparison of abdominal ultrasound, endoscopic ultrasound and magnetic resonance imaging in detection of necrotic debris in walled-off pancreatic necrosis. Gastroenterology report. 2015 Jan 7;4(1):50-3.
16. Bach AM, Loring LA, Hann LE, Illescas FF, Fong Y, Blumgart LH. Gallbladder cancer: can ultrasonography evaluate extent of disease?.Journal of ultrasound in medicine. 1998 May;17(5):303-9.
17. Kaur A., Malaviya A, Deepika, Kaur N. K. Comprehensive evaluation of MRCP versus ultra sonography in biliary obstruction. Int J Med Res Rev 2018;6 (03):143-152. doi:10.17511/ijmrr. 2018.i03.03.
18. Singh A, Mann HS, Thukral CL, Singh NR. Diagnostic accuracy of MRCP as compared to ultrasound/CT in patients with obstructive jaundice. Journal of clinical and diagnostic research: JCDR. 2014 Mar;8(3):103.
19. Masselli G, Gualdi G. Hilarcholangio-carcinoma: MRI/MRCP in staging and treatment planning. Abdominal imaging. 2008 Jul 1;33(4):444-51.
20. Kim TU, Kim S, Lee JW, Woo SK, Lee TH, Choo KS, Kim CW, Kim GH, Kang DH. Ampulla of Vater: comprehensive anatomy, MR imaging of pathologic conditions, and correlation with endoscopy. European journal of radiology. 2008 Apr 1;66(1):48-64
21. Frostberg N. A characteristic duodenal deformity in cases of different kinds of peri-vaterial enlargement of the pancreas. Actaradiologica. 1938 Mar(2):164-73.
22. Rickes S, Unkrodt K, Neye H, Ocran KW, Wermke W. Differentiation of pancreatic tumours by conventional ultrasound, unenhanced and echo-enhanced power Doppler sonography. Scandinavian journal of gastroenterology. 2002 Jan 1;37(11): 1313-20.
23. Jalli R, Jafari SH, Sefidbakht S, Kazemi K. Comparison of the accuracy of DWI and ultrasonography in screening hepatocellular carcinoma in patients with chronic liver disease. Iranian Journal of Radiology. 2015 Jan;12(1).

Dr Kuncham Nagabalaji

Final Year Post Graduate, Department of Radiodiagnosis KIMS & RF