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Zhong-Wei Ke, Cheng-Zhu Zheng, Ji-Hui Li, Kai Yin, Dan-Lei Chen, Ming-Gen Hu, Ji-De Hua, Department of Minimally Invasive Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
Correspondence to: Dr. Zhong-Wei Ke, Department of Minimally Invasive Surgery, Changhai Hospital, Second Military Medical University, 174 Changhai Road, Shanghai 200433, China. weiz6@hotmail.com
Received: May 28, 2004 Revised: June 9, 2004 Accepted: June 28, 2004 Published online: September 15, 2004
AIM: To evaluate the clinical predictive value of magnetic resonance cholangiography (MRC) in selected patients before laparoscopic cholecystectomy (LC).
METHODS: A total of 267 patients scheduled for elective LC from March 1999 to May 2001, with risk factors for common bile duct (CBD) stones, underwent MRC followed by endoscopic retrograde cholangiography (ERC) or intraoperative cholangiography (IOC) to detect the stones in common bile duct and value accuracy of MRC. Suspected patient selection was based on clinical, ultrasonographic, and laboratory criteria. All those with a history of previous jaundice, previous mild gallstone pancreatitis (acute abdominal pain and at least a fourfold increase in serum amylase activity), abnormal liver function test results (especially abnormal bilirubin result) or a dilated common bile duct (more than 8 mm) on ultrasonography were considered to have high suspicion for choledocholithiasis.
RESULTS: During a 26-month period, 267 patients were studied. MRC identified all patients (78 patients) found to have CBD stones by ERC or laparoscopic cholangiography in the study group. 7 patients were incorrectly diagnosed as having CBD stones by MRC. In our study, MRC had a sensitivity of 100.0%, specificity of 96.3%, positive predictive value of 91.8% and negative predictive value of 100.0% for the detection of common bile duct stones. There were 19 patients (7.1%) occurring the ERC procedure-related complications; 11 patients were cholangitis, 7 pancreatitis, and 1 papillary bleeding. The information obtained from MRC could be utilized to select patients who would benefit from preoperative ERC. Using the information, 68.2% (182/267) patients in our group could be away from ERC and its distress. And the complications of preoperative examination would be minimized significantly.
CONCLUSION: ERC is an invasive technique with a well-documented complication rate. MRC is an accurate and simple non-invasive imaging technique for preoperative screening for CBD stones in at-risk patients, which could minimize the need for non-therapeutic ERC.
Key Words: N/A
Citation: Ke ZW, Zheng CZ, Li JH, Yin K, Chen DL, Hu MG, Hua JD. Evaluation of magnetic resonance cholangiography in patients with suspected common bile duct stones before laparoscopic cholecystectomy. Shijie Huaren Xiaohua Zazhi 2004; 12(9): 2143-2146
Liu TH, Consorti ET, Kawashima A, Ernst RD, Black CT, Greger PH Jr, Fischer RP, Mercer DW. The efficacy of magnetic resonance cholangiography for the evaluation of patients with suspected choledocholithiasis before laparoscopic cholecystectomy.Am J Surg. 1999;178:480-484.
[PubMed] [DOI]
Napoléon B, Dumortier J, Keriven-Souquet O, Pujol B, Ponchon T, Souquet JC. Do normal findings at biliary endoscopic ultrasonography obviate the need for endoscopic retrograde cholangiography in patients with suspicion of common bile duct stone? A prospective follow-up study of 238 patients.Endoscopy. 2003;35:411-415.
[PubMed] [DOI]
Sharma SK, Larson KA, Adler Z, Goldfarb MA. Role of endoscopic retrograde cholangiopancreatography in the management of suspected choledocholithiasis.Surg Endosc. 2003;17:868-871.
[PubMed] [DOI]
Kats J, Kraai M, Dijkstra AJ, Koster K, Ter Borg F, Hazenberg HJ, Eeftinck Schattenkerk M, des Plantes BG, Eddes EH. Magnetic resonance cholangiopancreaticography as a diagnostic tool for common bile duct stones: a comparison with ERCP and clinical follow-up.Dig Surg. 2003;20:32-37.
[PubMed] [DOI]
Filippone A, Ambrosini R, Fuschi M, Marinelli T, Pinto D, Maggialetti A. Clinical impact of MR cholangiopancreatography in patients with biliary disease.Radiol Med. 2003;105:27-35.
[PubMed] [DOI]
Tripathi RP, Batra A, Kaushik S. Magnetic resonance cholangiopancreatography: evaluation in 150 patients.Indian J Gastroenterol. 2002;21:105-109.
[PubMed] [DOI]
Adamek HE, Breer H, Layer G, Riemann JF. Magnetic resonance cholangiopancreatography. The fine art of bilio-pancreatic imaging.Pancreatology. 2002;2:499-502.
[PubMed] [DOI]
Topal B, Van de Moortel M, Fieuws S, Vanbeckevoort D, Van Steenbergen W, Aerts R, Penninckx F. The value of magnetic resonance cholangiopancreatography in predicting common bile duct stones in patients with gallstone disease.Br J Surg. 2003;90:42-47.
[PubMed] [DOI]
Chen RC, Lin KY, Lii JM, Yang MT, Chen WT, Tu HY, Wang CS. MR cholangiopancreatography: prospective comparison of 3-dimensional turbo spin echo and single-shot turbo spin echo with ERCP.J Formos Med Assoc. 2003;102:172-177.
[PubMed] [DOI]
Griffin N, Wastle ML, Dunn WK, Ryder SD, Beckingham IJ. Magnetic resonance cholangiopancreatography versus endoscopic retrograde cholangiopancreatography in the diagnosis of choledocholithiasis.Eur J Gastroenterol Hepatol. 2003;15:809-813.
[PubMed] [DOI]
Ainsworth AP, Rafaelsen SR, Wamberg PA, Durup J, Pless TK, Mortensen MB. Is there a difference in diagnostic accuracy and clinical impact between endoscopic ultrasonography and magnetic resonance cholangiopancreatography?Endoscopy. 2003;35:1029-1032.
[PubMed] [DOI]
Dalal PU, Howlett DC, Sallomi DF, Marchbank ND, Watson GM, Marr A, Dunk AA, Smith AD. Does intravenous glucagon improve common bile duct visualisation during magnetic resonance cholangiopancreatography? Results in 42 patients.Eur J Radiol. 2004;49:258-261.
[PubMed] [DOI]
Kaltenthaler E, Vergel YB, Chilcott J, Thomas S, Blakeborough T, Walters SJ, Bouchier H. A systematic review and economic evaluation of magnetic resonance cholangiopancreatography compared with diagnostic endoscopic retrograde cholangiopancreatography.Health Technol Assess. 2004;8:iii, 1-89.
[PubMed] [DOI]
Rösch T, Meining A, Frühmorgen S, Zillinger C, Schusdziarra V, Hellerhoff K, Classen M, Helmberger H. A prospective comparison of the diagnostic accuracy of ERCP, MRCP, CT, and EUS in biliary strictures.Gastrointest Endosc. 2002;55:870-876.
[PubMed] [DOI]
Hünerbein M, Stroszczynski C, Ulmer C, Handke T, Felix R, Schlag PM. Prospective comparison of transcutaneous 3-dimensional US cholangiography, magnetic resonance cholangiography, and direct cholangiography in the evaluation of malignant biliary obstruction.Gastrointest Endosc. 2003;58:853-858.
[PubMed] [DOI]
Sun XD, Cai XY, Li JD, Cai XJ, Mu YP, Wu JM. Prospective study of scoring system in selective intraoperative cholangiography during laparoscopic cholecystectomy.World J Gastroenterol. 2003;9:865-867.
[PubMed] [DOI]
Wei Q, Wang JG, Li LB, Li JD. Management of choledocholithiasis: comparison between laparoscopic common bile duct exploration and intraoperative endoscopic sphincterotomy.World J Gastroenterol. 2003;9:2856-2858.
[PubMed] [DOI]
Liu TH, Consorti ET, Kawashima A, Tamm EP, Kwong KL, Gill BS, Sellin JH, Peden EK, Mercer DW. Patient evaluation and management with selective use of magnetic resonance cholangiography and endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy.Ann Surg. 2001;234:33-40.
[PubMed] [DOI]
Boraschi P, Gigoni R, Braccini G, Lamacchia M, Rossi M, Falaschi F. Detection of common bile duct stones before laparoscopic cholecystectomy. Evaluation with MR cholangiography.Acta Radiol. 2002;43:593-598.
[PubMed] [DOI]
Li JH, Zheng CZ, Ke CW, Yin K. Management of aberrant bile duct during laparoscopic cholecystectomy.Hepatobiliary Pancreat Dis Int. 2002;1:438-441.
[PubMed] [DOI]
Ke ZW, Zheng CZ, Li JH, Yin K, Hua JD. Prospective evaluation of magnetic resonance cholangiography in patients with suspected common bile duct stones before laparoscopic cholecystectomy.Hepatobiliary Pancreat Dis Int. 2003;2:576-580.
[PubMed] [DOI]
