Abstract 486: MRCP vs ERCP in the Diagnosis of Bile Duct Obstruction: A Randomized Clinical Trial
AUTHORS:
C. Reinhold, MD, A.N. Barkun, MD, J. Barkun, MD, L. Joseph, MD, E. Valois, M. Burke, MD.
ABSTRACT:
PURPOSE: To evaulate the accuracy of MR cholangiopancreatography (MRCP) in the evaluation of patients with suspected bile duct obstruction (BDO) in the setting of a randomized controlled clinical trial.
METHOD AND MATERIALS: 123 consecutive patients with suspected BDO (clinical, laboratory, US/CT) were randomized either to MRCP [n=61, 49.6%] or endoscopic retrograde cholangiopancreatography (ERCP) [n=62, 50.4%]. Block randomization was perfomed according to suspected level of obstruction at US/CT using sealed envelopes. MRCP examinations were performed using a multicoil array, and a combination of single shot fast spin-echo (coronal, axial, 5mm, 256 x 256)and 2D fast spin-echo high resolution sequences (axial, 3mm, 512 x 256).
RESULTS: Of the 61 patients randomized to MRCP, 33 (54.1%) were diagnosed with BDO while 28 (45.9%) had no BDO at MRCP. The etiology of BDO at MRCP was as follows: common bile duct (CBD) stones (n=18), undetermined distal obstruction (n=8), pancreatic carcinoma (n=2), cholangiocarcinoma (n=2), inflammatory (n=2), and chronic pancreatitis (n=1). 27 patients or 44.2% underwent ERCP after MRCP. The ERCP and MRCP results were concordant in 23 or 85%. In two patients, MRCP diagnosed small distal CBD stones (2-3mm); however, ERCP was unsuccessful and the patients remained asymptomatic. In 2 patients, MRCP diagnosed CBD stones, which were not seen at ERCP performed one and 17 days after the MRCP. Of the patients with no BDO at MRCP, no biliary pathology has been found at 6 months to one year follow-up.
CONCLUSIONS: Although these results are still preliminary, MRCP appears to be an accurate test for selecting out which patients would benefit from an ERCP in the work-up of clinically suspected BDO.
