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. 1999 Jan;44(1):118–122. doi: 10.1136/gut.44.1.118

Use of magnetic resonance cholangiography in the diagnosis of choledocholithiasis: prospective comparison with a reference imaging method

S Zidi 1, F Prat 1, O Le Guen 1, Y Rondeau 1, L Rocher 1, J Fritsch 1, A Choury 1, G Pelletier 1
PMCID: PMC1760072  PMID: 9862837

Abstract

Background—Magnetic resonance cholangiography (MRC) is a new technique for non-invasive imaging of the biliary tract. 
Aim—To assess the results of MRC in patients with suspected bile duct stones as compared with those obtained with reference imaging methods. 
Patients/Methods—70 patients (34 men and 36 women, mean (SD) age 71 (15.5) years; median 75) with suspected bile duct stones were included (cholangitis, 33; pancreatitis, three; suspected post-cholecystectomy choledocholithiasis, nine; cholestasis, six; stones suspected on ultrasound or computed tomography scan, 19). MR cholangiograms with two dimensional turbo spin echo sequences were acquired. Endoscopic retrograde cholangiography with or without sphincterotomy (n = 63), endosonography (n = 5), or intraoperative cho- langiography (n = 2) were the reference imaging techniques used for the study and were performed within 12 hours of MRC. Radiologists were blinded to the results of endoscopic retrograde cholangiography and previous investigations. 
Results—49 patients (70%) had bile duct stones on reference imaging (common bile duct, 44, six of which impacted in the papilla; intrahepatic, four; cystic duct stump, one). Stone size ranged from 1 to 20 mm (mean 6.1, median 5.5). Twenty seven patients (55%) had bile duct stones smaller than 6 mm. MRC diagnostic accuracy for bile duct lithiasis was: sensitivity, 57.1%; specificity, 100%; positive predictive value, 100%; negative predictive value, 50%. 
Conclusions—Stones smaller than 6 mm are still often missed by MRC when standard equipment is used. The general introduction of new technical improvements is needed before this method can be considered reliable for the diagnosis of bile duct stones. 



Keywords: bile duct calculi; endoscopic retrograde cholangiography; magnetic resonance cholangiography

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Figure 1 .

Figure 1

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Coronal magnetic resonance cholangiography image showing a single 8 mm stone within the lower common bile duct. The common bile duct is slightly dilated (8.5 mm). 


Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Assouline Y., Liguory C., Ink O., Fritsch J., Choury A. D., Lefebvre J. F., Pelletier G., Buffet C., Etienne J. P. Résultats actuels de la sphinctérotomie endoscopique pour lithiase de la voie biliaire principale. Gastroenterol Clin Biol. 1993;17(4):251–258. [PubMed] [Google Scholar]
  2. Barish M. A., Yucel E. K., Soto J. A., Chuttani R., Ferrucci J. T. MR cholangiopancreatography: efficacy of three-dimensional turbo spin-echo technique. AJR Am J Roentgenol. 1995 Aug;165(2):295–300. doi: 10.2214/ajr.165.2.7618543. [DOI] [PubMed] [Google Scholar]
  3. Becker C. D., Grossholz M., Becker M., Mentha G., de Peyer R., Terrier F. Choledocholithiasis and bile duct stenosis: diagnostic accuracy of MR cholangiopancreatography. Radiology. 1997 Nov;205(2):523–530. doi: 10.1148/radiology.205.2.9356639. [DOI] [PubMed] [Google Scholar]
  4. Boyer J. Sphinctérotomie endoscopique et lithiase de la voie biliaire principale. Réalités et perspectives. Gastroenterol Clin Biol. 1993;17(4):241–243. [PubMed] [Google Scholar]
  5. Chan F. L., Chan J. K., Leong L. L. Modern imaging in the evaluation of hepatolithiasis. Hepatogastroenterology. 1997 Mar-Apr;44(14):358–369. [PubMed] [Google Scholar]
  6. Chan Y. L., Chan A. C., Lam W. W., Lee D. W., Chung S. S., Sung J. J., Cheung H. S., Li A. K., Metreweli C. Choledocholithiasis: comparison of MR cholangiography and endoscopic retrograde cholangiography. Radiology. 1996 Jul;200(1):85–89. doi: 10.1148/radiology.200.1.8657949. [DOI] [PubMed] [Google Scholar]
  7. Freeman M. L., Nelson D. B., Sherman S., Haber G. B., Herman M. E., Dorsher P. J., Moore J. P., Fennerty M. B., Ryan M. E., Shaw M. J. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996 Sep 26;335(13):909–918. doi: 10.1056/NEJM199609263351301. [DOI] [PubMed] [Google Scholar]
  8. Guibaud L., Bret P. M., Reinhold C., Atri M., Barkun A. N. Bile duct obstruction and choledocholithiasis: diagnosis with MR cholangiography. Radiology. 1995 Oct;197(1):109–115. doi: 10.1148/radiology.197.1.7568807. [DOI] [PubMed] [Google Scholar]
  9. Hall-Craggs M. A., Allen C. M., Owens C. M., Theis B. A., Donald J. J., Paley M., Wilkinson I. D., Chong W. K., Hatfield A. R., Lees W. R. MR cholangiography: clinical evaluation in 40 cases. Radiology. 1993 Nov;189(2):423–427. doi: 10.1148/radiology.189.2.8210370. [DOI] [PubMed] [Google Scholar]
  10. Holzknecht N., Gauger J., Sackmann M., Thoeni R. F., Schurig J., Holl J., Weinzierl M., Helmberger T., Paumgartner G., Reiser M. Breath-hold MR cholangiography with snapshot techniques: prospective comparison with endoscopic retrograde cholangiography. Radiology. 1998 Mar;206(3):657–664. doi: 10.1148/radiology.206.3.9494483. [DOI] [PubMed] [Google Scholar]
  11. Ishizaki Y., Wakayama T., Okada Y., Kobayashi T. Magnetic resonance cholangiography for evaluation of obstructive jaundice. Am J Gastroenterol. 1993 Dec;88(12):2072–2077. [PubMed] [Google Scholar]
  12. Kubo S., Hamba H., Hirohashi K., Kinoshita H., Lee K. C., Yamazaki O., Nishio H., Yamada R. Magnetic resonance cholangiography in hepatolithiasis. Am J Gastroenterol. 1997 Apr;92(4):629–632. [PubMed] [Google Scholar]
  13. Lenriot J. P., Le Neel J. C., Hay J. M., Jaeck D., Millat B., Fagniez P. L. Cholangio-pancréatographie rétrograde et sphinctérotomie endoscopique pour lithiase biliaire. Evaluation prospective en milieu chirurgical. Gastroenterol Clin Biol. 1993;17(4):244–250. [PubMed] [Google Scholar]
  14. Lightdale C. J. Indications, contraindications, and complications of endoscopic ultrasonography. Gastrointest Endosc. 1996 Feb;43(2 Pt 2):S15–S19. doi: 10.1016/s0016-5107(96)81508-2. [DOI] [PubMed] [Google Scholar]
  15. Macaulay S. E., Schulte S. J., Sekijima J. H., Obregon R. G., Simon H. E., Rohrmann C. A., Jr, Freeny P. C., Schmiedl U. P. Evaluation of a non-breath-hold MR cholangiography technique. Radiology. 1995 Jul;196(1):227–232. doi: 10.1148/radiology.196.1.7784572. [DOI] [PubMed] [Google Scholar]
  16. McDermott V. G., Nelson R. C. MR cholangiopancreatography: efficacy of three-dimensional turbo spin-echo technique. AJR Am J Roentgenol. 1995 Aug;165(2):301–302. doi: 10.2214/ajr.165.2.7618544. [DOI] [PubMed] [Google Scholar]
  17. Miyazaki T., Yamashita Y., Tsuchigame T., Yamamoto H., Urata J., Takahashi M. MR cholangiopancreatography using HASTE (half-Fourier acquisition single-shot turbo spin-echo) sequences. AJR Am J Roentgenol. 1996 Jun;166(6):1297–1303. doi: 10.2214/ajr.166.6.8633435. [DOI] [PubMed] [Google Scholar]
  18. Palazzo L., Girollet P. P., Salmeron M., Silvain C., Roseau G., Canard J. M., Chaussade S., Couturier D., Paolaggi J. A. Value of endoscopic ultrasonography in the diagnosis of common bile duct stones: comparison with surgical exploration and ERCP. Gastrointest Endosc. 1995 Sep;42(3):225–231. doi: 10.1016/s0016-5107(95)70096-x. [DOI] [PubMed] [Google Scholar]
  19. Pasanen P., Partanen K., Pikkarainen P., Alhava E., Pirinen A., Janatuinen E. Ultrasonography, CT, and ERCP in the diagnosis of choledochal stones. Acta Radiol. 1992 Jan;33(1):53–56. [PubMed] [Google Scholar]
  20. Pavone P., Laghi A., Catalano C., Broglia L., Messina A., Scipioni A., Di Girolamo M., Passariello R. MR cholangiopancreatography (MRCP) at 0.5 T: technique optimisation and preliminary results. Eur Radiol. 1996;6(2):147–152. doi: 10.1007/BF00181131. [DOI] [PubMed] [Google Scholar]
  21. Prat F., Amouyal G., Amouyal P., Pelletier G., Fritsch J., Choury A. D., Buffet C., Etienne J. P. Prospective controlled study of endoscopic ultrasonography and endoscopic retrograde cholangiography in patients with suspected common-bileduct lithiasis. Lancet. 1996 Jan 13;347(8994):75–79. doi: 10.1016/s0140-6736(96)90208-1. [DOI] [PubMed] [Google Scholar]
  22. Prat F., Jaoudé J. B., Ink O., Fritsch J., Choury A. D., Assouline Y., Etienne J. P. Endoscopic sphincterotomy for suspected choledocholithiasis in patients with and without stones. Am J Gastroenterol. 1995 May;90(5):727–731. [PubMed] [Google Scholar]
  23. Reinhold C., Bret P. M. Current status of MR cholangiopancreatography. AJR Am J Roentgenol. 1996 Jun;166(6):1285–1295. doi: 10.2214/ajr.166.6.8633434. [DOI] [PubMed] [Google Scholar]
  24. Soto J. A., Barish M. A., Yucel E. K., Siegenberg D., Ferrucci J. T., Chuttani R. Magnetic resonance cholangiography: comparison with endoscopic retrograde cholangiopancreatography. Gastroenterology. 1996 Feb;110(2):589–597. doi: 10.1053/gast.1996.v110.pm8566608. [DOI] [PubMed] [Google Scholar]
  25. Soto J. A., Yucel E. K., Barish M. A., Chuttani R., Ferrucci J. T. MR cholangiopancreatography after unsuccessful or incomplete ERCP. Radiology. 1996 Apr;199(1):91–98. doi: 10.1148/radiology.199.1.8633178. [DOI] [PubMed] [Google Scholar]

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