Published online Mar 21, 2015. doi: 10.3748/wjg.v21.i11.3351
Peer-review started: July 7, 2014
First decision: August 15, 2014
Revised: August 26, 2014
Accepted: October 15, 2014
Article in press: October 15, 2014
Published online: March 21, 2015
AIM: To evaluate the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) in patients with choledocholithiasis.
METHODS: We systematically searched MEDLINE, EMBASE, Web of Science, and Cochrane databases for studies reporting on the sensitivity, specificity and other accuracy measures of diagnostic effectiveness of MRCP for detection of common bile duct (CBD) stones. Pooled analysis was performed using random effects models, and receiver operating characteristic curves were generated to summarize overall test performance. Two reviewers independently assessed the methodological quality of studies using standards for reporting diagnostic accuracy and quality assessment for studies of diagnostic accuracy tools.
RESULTS: A total of 25 studies involving 2310 patients with suspected choledocholithiasis and 738 patients with CBD stones met the inclusion criteria. The average inter-rater agreement on the methodological quality checklists was 0.96. Pooled analysis of the ability of MRCP to detect CBD stones showed the following effect estimates: sensitivity, 0.90 (95%CI: 0.88-0.92, χ2 = 65.80; P < 0.001); specificity, 0.95 (95%CI: 0.93-1.0, χ2 = 110.51; P < 0.001); positive likelihood ratio, 13.28 (95%CI: 8.85-19.94, χ2 = 78.95; P < 0.001); negative likelihood ratio, 0.13 (95%CI: 0.09-0.18, χ2 = 6.27; P < 0.001); and diagnostic odds ratio, 143.82 (95%CI: 82.42-250.95, χ2 = 44.19; P < 0.001). The area under the receiver operating characteristic curve was 0.97. Significant publication bias was not detected (P = 0.266).
CONCLUSION: MRCP has high diagnostic accuracy for the detection of choledocholithiasis. MRCP should be the method of choice for suspected cases of CBD stones.
Core tip: Unlike endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography (MRCP) is noninvasive, can be performed rapidly and has demonstrated good results for the detection of common bile duct stones. Moreover, MRCP does not expose patients to ionizing radiation or iodinated contrast media, which is useful for evaluating biliopancreatic disease. However, the selective use of MRCP in clinically equivocal situations has not been explored until now. The goal of this study was to evaluate the effectiveness of MRCP for the detection of common bile duct stones in patients with suspected choledocholithiasis.