Role of MRCP in Biliary Obstruction: Comparison with ERCP/Surgery in Addis Ababa, Ethiopia (2025)
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Date
2025
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Addis Ababa University
Abstract
Background;-A fast growing noninvasive technique for Imaging assessing the hillary tree and pancreatic ducts is magnetic resonance cholangiopancreatography (MRCP). The effectiveness of MRCP to provide maximum intensity projection(MIP) images that closely resemble those produced by endoscopic retrograde cholagiopancetigraphy (ERCP) without the need for intravenous or oral contrast agents is one of its main advantages . It uses heavily T2 weighted imaging technique or sequences which result in the generation of bright signals from slow moving or static fluids like the bile fluid or secretion from the pancreas making these structures bright and the rest of the background will appear darker.(2)
Objectives;-To evaluate the diagnostic performance of MRCP in patients suspected biliary obstruction by assessing imaging features , determining etiologic causes,and comparing its diagnostic accuracy with ERCP and surgical findings
Methods;-A total of 112 patients from black lion hospital, lancet general hospital and MC comprehensive specialized hospital were included for this retrospective cross-sectional diagnostic accuracy study . There MRCP images were retrieved from PACs system and then interpreted by the body imaging subspecialist and fellow. Their surgical findings or ERCP findings were retrieved from the operational notes and their medical history were recovered from their hospital medical recording systems . Data was entered to epi info and then analysed with SPSS.
Results;-MRCP demonstrated high diagnostic performance, with an overall accuracy of approximately 91.1%, sensitivity of 94.7%, and specificity of 72.2%. The most common cause of biliary obstruction was CBD stones contributing for 43.5 % of cases followed by benign strictures and of no etiology cases .MRCP showed excellent diagnostic performance for CBD stones, with sensitivity exceeding 90% and specificity around 94%. A notable finding in this study was that 16.1% of patients demonstrated biliary dilatation without an identifiable obstructing etiology.
Conclusion and recommendation;-MRCP is a highly sensitive and accurate non-invasive imaging modality for evaluating biliary obstruction. It performs exceptionally well in detecting biliary dilatation and CBD stones and is highly reliable in excluding malignancy. However, limitations remain in detecting small stones and subtle lesions and in accurately characterizing strictures
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MRCP, ERCP, biliary obstruction, choledochlethiasis, biliary stricture, Addis Ababa University