Value of MR cholangiography in the diagnosis of obstructive diseases of the biliary tree: A study of 58 cases

Objective: The aim of this study was to evaluate magnetic resonance cholang iography (MRC) in the diagnosis of biliary tree obstruction. Methods: Fifty -eight consecutive patients underwent MRC (GYROSCAN ACS II 1.5 Tesla, TSE T 2 axial/coronal-MIP sequences) for clinical and biochemical signs of main b ile duct obstruction. MRC images were interpreted by two radiologists and c onsensus was established according to presence or absence of main bile duct dilation, choledocholithiasis, and malignant or benign stricture. MRC was compared to a final diagnosis established by ultrasound and CT in 19 cases, endoscopic retrograde cholangiopancreatography (ERCP) in 25, intraoperativ e cholangiography and exploration in 14, and clinical, biochemical, and his tological presentation when relevant. Included were single or multiple chol edocholithiasis (28, including 11 less than or equal to 3 mm), malignant (1 0) and benign (12) strictures, and intrahepatic cholestasis (9), Results: O verall, MRC was sensitive (94%) and specific (92%) in detecting main bile d uct dilation and choledocholithiasis (86% and 97%), but was less sensitive (64%) for small stones less than or equal to 3 mm, Sensitivity for stones > 3 mm was 100%, For benign and malignant strictures, MRC was less sensitive (67% and 80%) but remained specific (98% and 96%), In the detection of nor mal main bile duct, MRC was highly sensitive (100%) and specific (94%), Dia gnostic accuracy ranged from 91% to 98%, Conclusion: MRC appears to be spec ific for choledocholithiasis and sensitive except for small stones. Results for biliary stricture are less satisfactory, but remain specific. Our data confirm that MRC can be useful in the diagnostic workup of main bile duct obstruction. (C) 1998 by Am. Coll. of Gastroenterology.