MRCP metanalysis

8/8/2019 MRCP metanalysis

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Magnetic Resonance

Cholangiopancreatography: A Meta-Analysis ofTest Performance in Suspected Biliary Disease

Joseph Romagnuolo et al

Ann Intern Med. 2003;139:547-557.University of Calgary, Canada


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Introduction

MRCP a newer non invasive test that can

image the biliary tree

ERCP gold standard in suspected biliary

disease

1.3 9% pancreatitis

0.2 0.5% mortality


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Background

T2 W and rapid image acquisition allowbiliary imaging

Relatively stagnant fluid (Bile andpancreatic juice) high signal intensity

Low signal intensity of surrounding hepatic

and pancreatic tissue and fast flowing blood T1 W images of liver and pancreas give

additional information


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PurposeTo estimate the overall sensitivity and

specificity of MRCP in suspected biliary

obstruction and to evaluate clinically

important subgroups


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Methods Medline Jan 1987 Mar 2003

Inclusion

Acceptable gold standard

Intraop cholagiography

PTC

IV cholangiography

EUS Surgery

CT

Clinical follow up


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Imaging End Points

Presence of obstruction

Level of obstruction

Biliary lithiasis

Malignancy


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Statistical Methods Assessed sens and spec and negative

predictive value by noting

True Positive

True Negative

False Positive

False Negative


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Results Studies included: 67

Blinded studies: 40 (61%)

Gold standard included: 61 (92%)

Same gold standard in all pts: 20 (30%)

Presence of obstruction assessed: 30 studies (1954 pts)

28 (93%) gold standard used


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Results Level of obstruction assessed

8 studies (572 pts)

Ability to detect bile duct stones

46 studies (3592 pts)

35 (97%) used gold standard

For diagnosis of malignancy 22 studies (1294 pts)

21 (95%) used gold standard


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Sensitivity & Specificity

Overall Sens: 95% (75 99), Overall Spec: 94% (86 99)


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Discussion

Confirms high accuracy of MRCP indetecting biliary obstruction

Question on differentiating malignant andbenign causes

Low spatial resolution

I

nadequate depiction of contour of stricture Erroneous diagnosis of periampullary lesions

Performance better if wide spectrum of pts


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Discussion

Accuracy in stone detection declines with

decreasing size of stone

Sens 100 to 64% if stone < 3mm

Sens 100 to 62% if stone < 5mm

Blinding not assoc with performance


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Discussion

PSC

Diagnosis in > 90%

Failure to depict 3rd or 4th order intrahepatic

ducts

Important role in staging and planning mgt

of pancreatobiliary malignancies


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Conclusion Excellent overall sensitivity and specificity

for demonstrating the level and presence of

biliary obstruction Less sensitive for detecting stones &

differentiating malignant from benignobstruction

Role and cost effectiveness need to befurther reassessed


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Diagnosis of PSC: a blinded comparative

study using MRCP and ERCP

SL. Moff et al

Gastrointest Endosc 2006;64:219-23

Johns Hopkins University School of Medicine, Baltimore


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AimTo determine the diagnostic accuracy and

interobserver agreement of ERC and MRC

in PSC


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Methods ERCs and MRCs of 36 patients with PSC

and 51 controls

Read in an blinded, and random fashion by

2 MR radiologists and 2 interventional

endoscopists by using a validated

classification system


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Conclusion ERC and MRC comparable for diagnosing PSC

Good inter-observer agreement for the diag of

PSC and IHD strictures

Only ERC had good agreement for EHD

strictures.

Inter-observer agreement was very poor for bothMRC and ERC when disease severity of PSC was

assessed


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False Positive MRCP

Stricture of the confluence of the hepatic ducts

(arrow) and the common bile duct (arrowhead)

with intrahepatic ductal dilatation

ERCP of the same patient reveals better

distension of the common bile duct.


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False Negative ERCP

ERCP image reveals normal Intra

and extrahepatic bile ducts

MRCP reveals intrahepatic ductal

dilatation on the left, with focal

stricture

Documents

MRCP metanalysis