EVALUATION OF OBSTRUCTIVE JAUNDICE BY ULTRASONOGRAPHY WITH MRCP CORRELATION

Sarbesh Tiwari P.G.T ,

Radiodiagnosis Assam Medical

college & Hospital Dibrugarh

INTRODUCTION Jaundice, or icterus, is a yellowish

discoloration of tissue resulting from the deposition of bilirubin

Causes – Obstructive (surgical) Non obstructive (medical) categories

Surgical jaundice has been defined as ductal pathology potentially correctable by surgery regardless of whether the biliary system was dilated

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AIMS AND OBJECTIVES

i. To evaluate the level and cause of obstruction in patients with obstructive jaundice.

ii. To correlate the Ultrasonographic findings with the MRCP findings.

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MATERIALS AND METHOD

Study period -- From June 2011, ongoing study.

Study Place -- Department of

Radiodiagnosis , Assam medical

college & Hospital

Sample size --39

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Inclusion criteria –

Any patients with obstructive jaundice confirmed by biochemical investigations and morphological criteria.

Exclusion Criteria –

All patients with medical jaundice and cirrhosis of liver

Claustrophobic/patients with breath holding difficulties were excluded from the study

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MATERIALS AND METHOD

MACHINES

USG machine Seimen Acusion Antres 5.0 ultrasound system.

MRCP Seimens Avanto 1.5 T Germany by using a

phased array multicoil

Conventional T1 and T2 sequences (in axial plane) followed by T2 haste in axial and coronal plane and thin-section 3D T2-fast spin echo images were taken

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MATERIALS AND METHOD

A final definitive diagnosis was done by

Operative findings on surgery with histopathological examination wherever possible

Follow up studies when treatment was conservative.

MATERIALS AND METHOD

RESULTS AND OBSERVATIONS

AGE DISTRIBUTION

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RESULTS AND OBSERVATIONS

SEX DISTRIBUTION

Male – 17

Female - 22

RESULTS AND OBSERVATIONS

BENIGN vs MALIGNANT

BENIGN – 24

MALIGNANT - 15

RESULTS AND OBSERVATIONS

Benign causesRESULTS AND OBSERVATIONS

Malignant causesRESULTS AND OBSERVATIONS

LEVEL OF OBSTRUCTION AS DETERMINED BY USG

Final Diagnosis(Confirmed Diagnosis)

Number (n)Cases

USG DIAGNOSIS

Correct

Indeterminate

Incorrect

Porta Hepatis 13 13 0 0

Suprapancreatic

16 14 1 1

Intrapancreatic

10 8 2 0

TOTAL 39 35 3 1

RESULTS AND OBSERVATIONS

LEVEL OF OBSTRUCTION AS DETERMINED BY MRCP

Final Dianosis(confirmed diagnosis)

Number (n)Cases

MRCP DIAGNOSIS

Correct Indeterminate

Incorrect

Porta Hepatis 13 13 0 0

Suprapancreatic

16 15 1 0

Intrapancreatic 10 9 1 0

TOTAL 39 37 2 015

RESULTS AND OBSERVATIONS

LEVELS OF OBSTRUCTIONRESULTS AND OBSERVATIONS

CAUSES DIAGNOSED BY USGFINAL DIAGNOSIS NUMBE

R (N)

USG DIAGNOSIS

CORRECT

INCORRECT

INDETERMINATE

CHOLEDOCHOLITHIASIS

14 12 1 1

GB NEOPLASM 7 7 0 0CHOLANGIO CARCINOMA

4 2 1 1

PERIAMPULLARY 4 3 1 0BENIGN STRICTURE 6 4 0 2CHOLEDOCHAL CYST 2 2 0 0MIRIZZI SYNDROME 1 0 0 1PORTAL BILOPATHY 1 0 0 1TOTAL 39 30 3 6

RESULTS AND OBSERVATIONS

CAUSES DIAGNOSED BY MRCP

FINAL DIAGNOSIS NUMBER (N)

MRCP DIAGNOSIS

CORRECT

INCORRECT

INDETERMINATE

CHOLEDOCHOLITHIASIS

14 13 0 1

GB NEOPLASM 7 7 0 0CHOLANGIO CARCINOMA

4 3 1 0

PERIAMPULLARY 4 4 0 0BENIGN STRICTURE 6 5 0 1CHOLEDOCHAL CYST 2 2 0 0MIRIZZI SYNDROME 1 1 0 0PORTAL BILOPATHY 1 1 0 0TOTAL 39 36 1 2

RESULTS AND OBSERVATIONS

RESULTS AND OBSERVATIONS

CASES

CASE 1: GB neck mass with InfiltrationA 39 yrs female presented with jaundice and upper abdominal discomfort

CASE 2: CHOLEDOCHOLITHIASIS

A 46 yrs female presenting with acute abdomen

CASE 3 :Hilar cholangiocarcinoma

A 70 yrs male presenting with painless jaundice and pruritus.

CASE 4 : Periampullary carcinomaA 52 yrs male presenting with increasing jaundice and upper abdominal vague pain

CASE 5: Benign stricture of CBDA 35 yrs female after cholecystectomy

CASE 6: Choledochal cyst

A 8 yrs girl presenting with intermittent jaundice

DISCUSSION Peak age group was 4th to 5th decade.

(Vakil et al: 35yrs-65 yrs)

F > M.

MC site of obstruction - Suprapancreatic part CBD (42% cases) followed by porta hepatis (33.3%).

USG and MRCP were comparative in diagnosis of obstruction at level of porta hepatis

Benign causes totaled 67% of the cases.

Calculus was the MC cause followed by benign stricture, choledochal cyst, Mirizzi syndrome and portal biliopathy.

Malignant neoplasms constituted 33% of cases.

The most common neoplasm causing obstruction was GB carcinoma in our study.

DISCUSSION

DISCUSSION

USG could correctly determine the Level of obstruction in 35 cases

(sensitivity of 90%)Cause of obstruction in 79% of cases.

MRCP could correctly determine the Level of obstruction in 38 cases (sensitivity of 95%) Cause of obstruction in 93 % of cases

* IJRI , 16:4, November 2006 ( V. upadhaya et al)# The Internet Journal of Tropical Medicine

Study USG MRCP

Level (%)

Cause (%)

Level (%)

Cause (%)

V.UpadhyayaEt al* (2006)

83.5 77 95.45 87.50

Sameer verma et al#

(2011)

91.8 87.3 91 90

Present study 90 79 95 93

DISCUSSION

Comparison with previous study

CONCLUSION Ultrasound remains an excellent

screening modality for determining obstruction in a patient with jaundice

MR cholangiography was found to be highly accurate non invasive methode in the detection of various etiology of obstruction.