MRCP vs. ERCP in the evaluation of biliary pathologies: review of current literature

Recently developed magnetic resonance (MR) techniques permit fast and correct imaging of the entire biliary tree with a high spatial resolution. The aim of this study was to compare the diagnostic potential of one of these new MR sequences in magnetic resonance cholangiopancreatography (MRCP) procedure and endoscopic retrograde cholangiopancreatography (ERCP) with review of current literatures.

A total of 295 patients were enrolled in this study prospectively. Of these, 11 were excluded from the study due to inadequate MRCP image quality and 15 more were excluded due to unsuccessful cannulation during ERCP. Thus, finally 269 patients (124 men and 145 women with a mean age of 57 years; range: 23-92 years) were included. The MRCP procedure was performed before the ERCP in all cases. All MRCP studies were performed with recently developed new MR technique using a heavily T2-weighted turbo spin echo (TSE) sequence. This TSE sequence is currently one of the most widely used multiplanar 3-D MR technique, having a high spatial resolution and fast imaging capacity.

The study participants were classified into four main groups; normal into group I, stone disease into group II, tumor into group III and others into group IV. Group I consisted of 228 patients who had a normal pancreaticobiliary tree on both the MRCP and ERCP examinations. In group II there were 18 patients, for whom the MRCP had a 88.9% sensitivity and a 100% specificity for diagnosing biliary stone disease. Its positive predictive value (PPV), negative predictive value (NPV) and accuracy rates were 100%, 99.2% and 99.2%, respectively. The MRCP had a 100% sensitivity and a 100% specificity for 20 patients in group III. It also had 100% PPV, 100% NPV, and 100% total accuracy rates in this group. In three patients in group IV, the MRCP had a 100% sensitivity and specificity, respectively. Its PPV, NPV and accuracy were 100%, 100% and 100%, respectively.

MRCP is used with increasing frequency as a non-invasive alternative to ERCP and the diagnostic results of MRCP with a heavily T2-weighted TSE MR sequence and ERCP are comparable with high accuracy in various hepatobiliary pathologies.