Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Radiol. Aug 28, 2013; 5(8): 304-312
Published online Aug 28, 2013. doi: 10.4329/wjr.v5.i8.304
Role of magnetic resonance cholangiopancreatography in diagnosing choledochal cysts: Case series and review
Vikas Y Sacher, James S Davis, Danny Sleeman, Javier Casillas
Vikas Y Sacher, James S Davis, Danny Sleeman, Department of Surgery, University of Miami, Miami, FL 33136, United States
Javier Casillas, Department of Radiology, University of Miami, Miami, FL 33101, United States
Author contributions: Sacher VY designed the study, collected and analyzed data and wrote the manuscript; Davis JS analyzed data and revised manuscript; Sleeman D designed study and revised manuscript; Casillas J designed study and revised manuscript; all authors approved the final version of the manuscript to be published.
Correspondence to: Javier Casillas, MD, Professor of Clinical Radiology, Chief of Abdominal Imaging, Department of Radiology, University of Miami, PO Box 016960 (R-109), Miami, FL 33101, United States. jcasilla@med.miami.edu
Telephone: +1-305-5857500 Fax: +1-305-5855743
Received: January 23, 2013
Revised: June 24, 2013
Accepted: August 4, 2013
Published online: August 28, 2013
Abstract

AIM: To determine the merits of magnetic resonance cholangiopancreatography (MRCP) as the primary diagnostic test for choledochal cysts (CC’s).

METHODS: Between 2009 and 2012, patients who underwent MRCP for perioperative diagnosis were identified. Demographic information, clinical characteristics, and radiographic findings were recorded. MRCP results were compared with intraoperative findings. A PubMed search identified studies published between 1996-2012, employing MRCP as the primary preoperative imaging and comparing results with either endoscopic retrograde cholangiopancreatography (ERCP) or operative findings. Detection rates for CC’s and abnormal pancreaticobiliary junction (APBJ) were calculated. In addition detection rates for clinically related biliary pathology like choledocholithiasis and cholangiocarcinomas in patients diagnosed with CC’s were also evaluated.

RESULTS: Eight patients were identified with CC’s. Six patients out of them had type IV CC’s, 1 had type I and 1 had a new variant of choledochal cyst with confluent dilatation of the common bile duct (CBD) and cystic duct. Seven patients had an APBJ and 3 of those had a long common-channel. Gallstones were found in 2 patients, 1 had a CBD stone, and 1 pancreatic-duct stone was also detected. In all cases, MRCP successfully identified the type of CC’s, as well as APBJ with ductal stones. From analyzing the literature, we found that MRCP has 96%-100% detection rate for CC’s. Additionally, we found that the range for sensitivity, specificity, and diagnostic accuracy was 53%-100%, 90%-100% and 56%-100% in diagnosing APBJ. MRCP’s detection rate was 100% for choledocholithiasis and 87% for cholangiocarcinomas with concurrent CC’s.

CONCLUSION: After initial ultrasound and computed tomography scan, MRCP should be the next diagnostic test in both adult and pediatric patients. ERCP should be reserved for patients where therapeutic intervention is needed.

Keywords: Magnetic resonance cholangiopancreatography, Choledochal cyst, Abnormal pancreaticobiliary junction, Diagnostic test, Choledocholithiasis, Cholangiocarcinomas

Core tip: Magnetic resonance cholangiopancreatography (MRCP) is used as primary diagnostic approach in various biliary pathologies. This is the first literature review of published studies discussing MRCP as a diagnostic modality for choledochal cysts. This review further outlines how recent imaging techniques have improved diagnostic accuracy of MRCP in diagnosing choledochal cysts and their associated anatomic variants. Advantages, disadvantages and contraindication for MRCP with respect to endoscopic retrograde cholangiopancreatography are also discussed.