Magnetic resonance cholangiopancreatography in patients with upper abdominal pain: a prospective study

To determine the role of magnetic resonance cholangiopancreatogram with conventional abdominal magnetic resonance examination in patients presenting clinically with upper abdominal pain and abnormal liver function tests and to compare the findings with endoscopic retrograde cholangiopancreatogram results.

Magnetic resonance cholangiopancreatogram and endoscopic retrograde cholangiopancreatogram were done in 77 patients. Conventional magnetic resonance examination of the liver and upper abdomen was done first followed by magnetic resonance cholangiopancreatogram using a half fourrier single shot turbo spin echo sequence. Conventional endoscopic retrograde cholangiopancreatogram was done by direct intraductal injection of radiographic contrast material through a duodenoscope under fluoroscopy control.

Endoscopic retrograde cholangiopancreatogram failed in 7 patients (9%) and Magnetic resonance cholangiopancreatogram images were inadequate in 3 patients (4%). The findings of adequate magnetic resonance exams in 74 patients were: choledocholithiasis in 24 patients (32%), bile duct stricture in 19 patients (26%), normal biliary ducts in 29 patients (39%) and dilated biliary ducts with no definite cause in 2 patients (3%). The findings of successful endoscopic retrograde cholangiopancreatograms in 67 patients after exclusion of inadequate magnetic resonance cholangiopancreatograms were: choledocholithiasis in 25 patients (37%), bile duct stricture in 18 patients (27%), normal biliary ducts in 21 patients (31%) and dilated biliary ducts with no evident cause in 2 patients (3%) and hemobilia in 1 patient (2%).

Magnetic resonance cholangiopancreatogram is a non-invasive technique, its accuracy is increased if it is combined with conventional abdominal magnetic resonance exam and it can replace the endoscopic retrograde cholangiopancreatogram.