Magnetic resonance cholangiopancreatography for diagnosing hepatolithiasis

Background/Aims: Direct cholangiography with endoscopic retrograde cholangi opancreatography and percutaneous transhepatic cholangiography sometimes fa ils to adequately opacify the entire biliary tract, because of severe bilia ry obstruction caused by ductal stricture or lodged stones. We assessed the diagnostic accuracy of magnetic resonance cholangiopancreatography for hep atolithiasis. Methodology: Five patients with hepatolithiasis underwent ultrasonography, computed tomography, direct cholangiography, and magnetic resonance cholang iopancreatography, using a half-Fourier acquisition single-shot turbo spin- echo sequence. Surgical exploration or pathologic examination revealed stri cture and dilatation of the intrahepatic ducts in all patients. Diagnostic accuracies for stones and ductal abnormalities were compared among the imag ing studies. Results: No complications occurred during magnetic resonance cholangiopancr eatography studies. Magnetic resonance cholangiopancreatography fully depic ted the biliary tract. Magnetic resonance cholangiopancreatography accurate ly detected and localized intrahepatic stones, as well as bile duct strictu re and dilatation, in all patients. Intrahepatic stones were detected by en doscopic retrograde cholangiopancreatography in one of four patients and by percutaneous transhepatic cholangiography in all three who underwent this procedure. Endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography demonstrated ductal stricture in all patients but failed to completely demonstrate the biliary tree in three of four pati ents, and one of three, respectively. On ultrasonography and computed tomog raphy, precise localization of stones was difficult. Ultrasonography and co mputed tomography failed to demonstrate ductal stricture in one and two of the five patients, respectively. Conclusions: Magnetic resonance cholangiopancreatography diagnoses intrahep atic stones and bile duct abnormalities less invasively and more accurately than endoscopic retrograde cholangiopancreatography and percutaneous trans hepatic cholangiography.