Role of MR cholangiopancreatography in patients with failed or inadequate ERCP

OBJECTIVE. The purpose of our study was to evaluate the usefulness of MR ch olangiopancreatography in the diagnosis and further treatment of patients w ith failed or inadequate ERCP. SUBJECTS AND METHODS. Fifty-eight patients with failed or inadequate ERCP u nderwent MR cholangiopancreatography using a two-dimensional heavily T2-wei ghted multislice fast spin-echo technique. The final diagnosis was made on the basis of a second ERCP (n = 4), percutaneous transhepatic cholangiopanc reatography (n = 19), intraoperative cholangiography (n = 6), percutaneous biopsy (n = 3), surgical findings (n = 5), or clinical follow-up (n = 21) f or a mean period of 22 months (range, 7-31 months). RESULTS. MR cholangiopancreatography was technically successful in 57 patie nts and resulted in a sensitivity, specificity, and diagnostic accuracy of 97.1%, 100%, and 98.2%, respectively. Overall, MR cholangiopancreatography gave clinically useful information that contributed to patient management i n 56 (96.6%) of the 58 patients. On the basis of the MR cholangiopancreatog raphy findings, patients were managed using a second ERCP (n = 4), combined percutaneous and endoscopic procedure (n = 2), percutaneous biliary stent insertion (n = 13), surgery (n = 12), chemotherapy (n = 1), or conservative treatment (n = 24). CONCLUSION. MR cholangiopancreatography was found to have a unique and valu able role in the investigation of patients in whom ERCP failed or was inade quate. MR cholangiopancreatography helped us avoid using invasive procedure s such as percutaneous transhepatic cholangiography in the diagnosis of bil e duct disease after failed ERCP.