Extrahepatic Biliary Obstruction: Magnetic Resonance Imaging Compared With Endoscopic Ultrasonography

Background and Study Aims: The aim of this study was to compare prospectively the diagnostic efficacy of magnetic resonance (MR) imaging and endoscopic ultrasonography (EUS) in extrahepatic biliary obstruction.

Patients and Methods: A total of 50 patients with suspected benign or malignant extrahepatic biliary obstruction underwent MR imaging, including MR cholangiopancreatography, and EUS, within a median time delay of 1 day. The final diagnosis was established by endoscopic retrograde cholangiopancreatography in 37 cases, intraoperative cholangiography in nine cases, and clinical and biochemical follow-up in four cases.

Results: In total, 33 patients had extrahepatic biliary obstruction, of benign origin in 21 cases and of malignant origin in 12 cases, whereas 17 had no evidence of obstruction. The sensitivity and specificity of MR imaging were 91 % and 94 %, respectively. There were one false-positive and three false-negative results, all related to choledochal sludge. The corresponding values for EUS were 97 % and 88 %. There were two false-positive results and one false-negative result. False-positive diagnoses were related to the presumed presence of biliary sludge and choledocholithiasis, whereas the false-negative diagnosis occurred in one patient with a final diagnosis of sludge. No significant difference in sensitivity and specificity was observed between the two imaging methods (P > 0.05).

Conclusion: In our study MR imaging was as accurate as EUS in the diagnosis of extrahepatic biliary obstruction.

References

• 1 Hauer-Jensen M, Karesen R, Nygaard K, et al. Predictive ability of choledocholithiasis indicators. A prospective evaluation.  Ann Surg. 1985;  202 64-68
• 2 Lacaine F, Corlette M B, Bismuth H. Preoperative evaluation of the risk of common bile duct stones.  Arch Surg. 1980;  115 1114-1116
• 3 Reiss R, Deutsch A A, Nudelman I, Kott I. Statistical value of various clinical parameters in predicting the presence of choledochal stones.  Surg Gynecol Obstet. 1984;  159 273-276
• 4 Amouyal P, Amouyal G, Mompoint D, et al. Endosonography: promising method for diagnosis of extrahepatic cholestasis.  Lancet. 1989;  2 1195-1198
• 5 Venu R P, Geenan J E, Toouli J, et al. Endoscopic retrograde cholangiopancreatography. Diagnosis of cholelithiasis in patients with normal gallbladder x-ray and ultrasound studies.  J Am Med Ass. 1983;  249 758-761
• 6 Freeny P C, Ball T J. Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous cholangiography (PTC) in the evaluation of suspected pancreatic carcinoma: diagnostic limitations and contemporary roles.  Cancer. 1981;  15 1666-1668
• 7 Freeman M L, Nelson D B, Sherman S, et al. Complications of endoscopic biliary sphincterotomy.  N Engl J Med. 1996;  335 909-918
• 8 Erickson R A, Carlson B. The role of endoscopic retrograde cholangiopancreatography in patients with laparoscopic cholecystectomies.  Gastroenterology. 1995;  109 252-263
• 9 Lai E C, Mok F P, Tan E S, et al. Endoscopic biliary drainage for severe acute cholangitis.  N Engl J Med. 1992;  326 1582-1586
• 10 Amouyal P, Amouyal G, Levy P, et al. Diagnosis of choledocholithiasis by endoscopic ultrasonography.  Gastroenterology. 1994;  106 1062-1067
• 11 Burtin P, Palazzo L, Canard J M, et al. Diagnostic strategies for extrahepatic cholestasis of indefinite origin: endoscopic or retrograde cholangiography? Results of a prospective study.  Endoscopy. 1997;  29 349-355
• 12 Prat F, Amouyal G, et al. Prospective controlled study of endoscopic ultrasonography and endoscopic retrograde cholangiography in patients with suspected common bile duct lithiasis.  Lancet. 1996;  347 75-79
• 13 Sugiyama M, Atomi Y. Endoscopic ultrasonography for diagnosing choledocholithiasis: a prospective comparative study with ultrasonography and computed tomography.  Gastrointest Endoscopy. 1997;  145 143-146
• 14 Aubertin J M, Levoir D, Bouillot J L, et al. Endoscopic ultrasonography immediately prior to laparoscopic cholecystectomy: a prospective evaluation.  Endoscopy. 1996;  28 667-673
• 15 Norton S A, Alderson D. Prospective comparison of endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography in the detection of bile duct stones.  Br J Surg. 1997;  84 1366-1369
• 16 Legmann P, Vignaux O, Dousset B, et al. Pancreatic tumors: comparison of dual-phase helical CT and endoscopic sonography.  Am J Roentgenol. 1998;  170 1315-1322
• 17 Brugge W R. Endoscopic ultrasonography: the current status.  Gastroenterology. 1998;  115 1577-1583
• 18 Becker C D, Grossholz M, Becker M, et al. Choledocholithiasis and bile duct stenosis: diagnostic accuracy of MR cholangiopancreatography.  Radiology. 1997;  205 523-525
• 19 Chan Y L, Chan A CW, Lam W M, et al. Choledocholithiasis: comparison of MR cholangiopancreatography and endoscopic retrograde cholangiopancreatography.  Radiology. 1996;  200 85-89
• 20 Guibaud L, Bret P M, Reinhold C, Atri M. Bile duct obstruction and choledocholithiasis: diagnosis with MR cholangiography.  Radiology. 1995;  197 109-115
• 21 Lee M G, Lee H J, Kim M H, et al. Extrahepatic biliary diseases: 3D MR cholangiopancreatography compared with endoscopic retrograde cholangiopancreatography.  Radiology. 1997;  202 663-669
• 22 Fulcher A S, Turner M A, Capps G W, et al. Half-Fourier RARE MR cholangiopancreatography: experience in 300 subjects.  Radiology. 1998;  207 21-32
• 23 Catalano C, Pavone P, Laghi A, et al. Pancreatic adenocarcinoma: combination of MR imaging, MR angiography and MR cholangiopancreatography for the diagnosis and assessment of resectability.  Eur J Radiol. 1998;  8 428-434
• 24 Schwartz L H, Coakley F V, Sun Y, et al. Neoplastic pancreatobiliary duct obstruction: evaluation with breath-hold MR cholangiopancreatography.  Am J Roentgenol. 1998;  170 1491-1495
• 25 Dancygier H, Nattermann C. The role of endoscopic ultrasonography in biliary tract disease: obstructive jaundice.  Endoscopy. 1994;  26 800-802
• 26 Trede M, Rumstadt B, Wendl K, et al. Ultrafast magnetic resonance imaging improves the staging of pancreatic tumors.  Ann Surg. 1997;  226 393-407
• 27 Sugiyama M, Atomi Y, Hachiya J. Magnetic resonance cholangiography using half-Fourier acquisition for diagnosing choledocholithiasis.  Am J Gastroenterol. 1998;  93 1886-1890
• 28 De Lédinghen V, Lecesne R, Raymond J M, et al. Diagnosis of choledocholithiasis: EUS or magnetic resonance cholangiography? A prospective controlled study.  Gastrointest Endosc. 1999;  49 26-31
• 29 McLean A, Fairclough P. Endoscopic ultrasound - current applications.  Clin Radiol. 1996;  51 83-98
• 30 Bret P M, Reinhold C. Magnetic resonance cholangiopancreatography.  Endoscopy. 1997;  29 472-486
• 31 Lee S P, Hayashi A, Kim Y S. Biliary sludge: curiosity or culprit?.  Hepatology. 1994;  20 523-525
• 32 Müller M F, Meyenberger C, Bertschinger P, et al. Pancreatic tumors: evaluation with endoscopic US, CT, and MR imaging.  Radiology. 1994;  190 745-751
• 33 Abboud P C, Malet P F, Berlin J A. Predictors of common bile duct stones prior to cholecystectomy: a meta-analysis.  Gastrointest Endosc. 1996;  44 450-459
• 34 Dahan P, Andant C, Lévy P, et al. Prospective evaluation of endoscopic ultrasonography and microscopic examination of duodenal bile in the diagnosis of cholecystolithiasis in 45 patients with normal conventional ultrasonography.  Gut. 1996;  38 277-281
• 35 Dill J E, Hill S, Callis J, et al. Combined endoscopic ultrasound and stimulated biliary drainage in cholecystitis and microlithiasis: diagnoses and outcomes.  Endoscopy. 1995;  27 424-427
• 36 Lee S P, Nicholls J F, Park H Z. Biliary sludge as a cause of acute pancreatitis.  N Engl J Med. 1992;  326 589-593
• 37 Rösch T, Dittler H J, Fockens P, et al. Major complications of endoscopic ultrasonography: results of a survey of 42105 cases (abstract).  Gastrointest Endosc. 1993;  39 341
• 38 Duprez P, Denis P, Devière J, et al. Complication rate in general practice of endosonography (abstract).  Gastrointest Endosc. 1997;  45 48
• 39 Acosta M J, Rossi R, Ledesma C L. The usefulness of stool screening for diagnosing choledocholithiasis in acute pancreatitis. A description of the technique.  Am J Dig Dis. 1977;  22 168-172