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Open Access 01-10-2018 | Original Article

Routine MRCP in the management of patients with gallbladder stones awaiting cholecystectomy: a single-centre experience

Authors: Valentina Virzì, Noemi Maria Giovanna Ognibene, Antonio Salvatore Sciortino, Glenda Culmone, Giuseppe Virzì

Published in: Insights into Imaging | Issue 5/2018

Abstract

Objectives

To assess the frequency of choledocolithiasis and the role of preoperative laboratory findings, ultrasound (US) and magnetic resonance cholangio-pancreatography (MRCP) in the detection of choledocolithiasis in patients with gallbladder stones awaiting cholecystectomy.

Methods

A consecutive sample of 104 patients underwent MRCP prior to cholecystectomy. The patients were classified into different groups on the basis of the risk of choledocolithiasis. A specialised doctor with more 10 years of experience performed the US interpretation and a radiologist performed the MRCP interpretation blinded to US or aspartate aminotransferase (AST)/alanine aminotransferase (ALT)/alkaline phosphatase (ALP) results. A chi-square (χ²) test was performed to assess the statistical significance of differences in the frequency of choledocolithiasis based on laboratory findings, choledocal diameter on US and group risk.

Results

MRCP showed calculi in 7 out of 104 patients (6.7%), with no statistically significant differences between the high/moderate risk and low/no risk groups and between the patients with normal and altered laboratory findings or choledocal diameter on preoperative US. The sensitivity and specificity of AST/ALT [positive predictive value (PPV): 12%; negative predictive value (NPV): 94%], ALP (PPV: 7%; NPV: 94%), total serum bilirubin (PPV: 6%; NPV: 93%) and choledocal diameter (PPV: 20%; NPV: 94%) were, respectively, 28.6 and 94.8%, 85.7 and 17.5%, 14.3 and 93.8%, and 14.3 and 95.9%.

Conclusions

MRCP is a reliable evaluation for the detection of common bile duct (CBD) stones, reducing the misdiagnosis of retained choledocholithiasis with normal biochemical predictors and US examination.

Main messages

• MRCP is a non-invasive method for the detection of CBD stones.

• Preoperative MRCP reduces the misdiagnosis of retained choledocholithiasis.

• Detection of choledocholithiasis is mandatory prior to cholecystectomy to avoid surgical morbidity

Mercer S, Singh S, Paterson I (2007) Selective MRCP in the management of suspected common bile duct stones. HPB (Oxford) 9(2):125–130CrossRef

Topal B, Van de Moortel M, Fieuws S et al (2003) The value of magnetic resonance cholangiopancreatography in predicting common bile duct stones in patients with gallstone disease. Br J Surg 90:42–47CrossRef

Dwerryhouse SJ, Brown E, Vipond MN (1998) Prospective evaluation of magnetic resonance cholangiography to detect common bile duct stones before laparoscopic cholecystectomy. Br J Surg 85:1364–1366CrossRef

Ke ZW, Zheng CZ, Li JH, Yin K, Hua JD (2003) Prospective evaluation of magnetic resonance cholangiography in patients with suspected common bile duct stones before laparoscopic cholecystectomy. Hepatobiliary Pancreat Dis Int 2:576–580PubMed

Desai R, Shokouhi BN (2009) Common bile duct stones - their presentation, diagnosis and management. Indian J Surg 71(5):229–237CrossRef

Peng WK, Sheikh Z, Paterson-Brown S, Nixon SJ (2005) Role of liver function tests in predicting common bile duct stones in acute calculous cholecystitis. Br J Surg 92(10):1241–1247CrossRef

Sgourakis G, Dedemadi G, Stamatelopoulos A, Leandros E, Voros D, Karaliotas K (2005) Predictors of common bile duct lithiasis in laparoscopic era. World J Gastroenterol 11(21):3267–3272CrossRef

Kim JH, Kim MJ, Park SI et al (2002) MR cholangiography in symptomatic gallstones: diagnostic accuracy according to clinical risk group. Radiology 224:410–416CrossRef

Trondsen E, Edwin B, Reiertsen O, Faerden AE, Fagertun H, Rosseland AR (1998) Prediction of common bile duct stones prior to cholecystectomy: a prospective validation of a discriminant analysis function. Arch Surg 133:162–166CrossRef

10.

Kim YJ, Kim MJ, Kim KW et al (2005) Preoperative evaluation of common bile duct stones in patients with gallstone disease. AJR Am J Roentgenol 184(6):1854–1859CrossRef

11.

Alponat A, Kum CK, Rajnakova A, Koh BC, Goh PM (1997) Predictive factors for synchronous common bile duct stones in patients with cholelithiasis. Surg Endosc 11(9):928–932CrossRef

12.

Freitas ML, Bell RL, Duffy AJ (2006) Choledocholithiasis: evolving standards for diagnosis and management. World J Gastroenterol 12(20):3162–3167CrossRef

13.

Mandelia A, Gupta AK, Verma DK, Sharma S (2013) The value of magnetic resonance cholangio-pancreatography (MRCP) in the detection of choledocholithiasis. J Clin Diagn Res 7(9):1941–1945PubMedPubMedCentral

14.

Videhult P, Sandblom G, Rudberg C, Rasmussen IC (2011) Are liver function tests, pancreatitis and cholecystitis predictors of common bile duct stones? Results of a prospective, population-based, cohort study of 1171 patients undergoing cholecystectomy. HPB (Oxford) 13(8):519–527CrossRef

15.

Abboud PA, Malet PF, Berlin JA et al (1996) Predictors of common bile duct stones prior to cholecystectomy: a meta-analysis. Gastrointest Endosc 44(4):450–455CrossRef

16.

Barkun AN, Barkun JS, Fried GM et al (1994) Useful predictors of bile duct stones in patients undergoing laparoscopic cholecystectomy. McGill Gallstone Treatment Group. Ann Surg 220(1):32–39CrossRef

17.

Onken JE, Brazer SR, Eisen GM et al (1996) Predicting the presence of choledocholithiasis in patients with symptomatic cholelithiasis. Am J Gastroenterol 91(4):762–767PubMed

18.

Paolo P, Nicoletta P, Carla M, Andrea M (1990) Ultrasonographic diagnosis of choledocholithiasis. Acta Biomed Ateneo Parmense 61(5–6):213–218PubMed

19.

Nebiker CA, Baierlein SA, Beck S, von Flüe M, Ackermann C, Peterli R (2009) Is routine MR cholangiopancreatography (MRCP) justified prior to cholecystectomy? Langenbecks Arch Surg 394(6):1005–1010CrossRef

20.

Cronan JJ, Mueller PR, Simeone JF et al (1983) Prospective diagnosis of choledocholithiasis. Radiology 146:467–469CrossRef

21.

Einstein DM, Lapin SA, Ralls PW, Halls JM (1984) The insensitivity of sonography in the detection of choledocholithiasis. AJR Am J Roentgenol 142:725–728CrossRef

22.

Laing FC, Jeffrey RB, Wing VW (1984) Improved visualization of choledocholithiasis by sonography. AJR Am J Roentgenol 143:949–952CrossRef

23.

Cronan JJ (1986) US diagnosis of choledocholithiasis: a reappraisal. Radiology 161:133–134CrossRef

24.

Giljaca V, Gurusamy KS, Takwoingi Y et al (2015) Endoscopic ultrasound versus magnetic resonance cholangiopancreatography for common bile duct stones. Cochrane Data Syst Rev (2):CD011549. https://doi.org/10.1002/14651858.CD011549

25.

Couse N, Egan T, Delaney P (1996) Intravenous cholangiography reduces the need for endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy. Br J Surg 83(3):335CrossRef

26.

Hallal AH, Amortegui JD, Jeroukhimov IM et al (2005) Magnetic resonance cholangiopancreatography accurately detects common bile duct stones in resolving gallstone pancreatitis. J Am Coll Surg 200(6):869–875CrossRef

27.

Romagnuolo J, Bardou M, Rahme E, Joseph L, Reinhold C, Barkun AN (2003) Magnetic resonance cholangiopancreatography: a meta-analysis of test performance in suspected biliary disease. Ann Intern Med 139(7):547–557CrossRef

28.

Menezes N, Marson LP, debeaux AC, Muir IM, Auld CD (2000) Prospective analysis of a scoring system to predict choledocholithiasis. Br J Surg 87(9):1176–1181CrossRef

29.

Jendresen MB, Thorbøll JE, Adamsen S, Nielsen H, Grønvall S, Hart-Hansen O (2002) Preoperative routine magnetic resonance cholangiopancreatography before laparoscopic cholecystectomy: a prospective study. Eur J Surg 168(1):690–694CrossRef

30.

Pavone P, Laghi A, Lomanto D et al (1997) MR cholangiography (MRC) in the evaluation of CBD stones before laparoscopic cholecystectomy. Surg Endosc 11(10):982–985CrossRef

31.

Carlos RC, Scheiman JM, Hussain HK, Song JH, Francis IR, Fendrick AM (2003) Making cost-effectiveness analyses clinically relevant: the effect of provider expertise and biliary disease prevalence on the economic comparison of alternative diagnostic strategies. Acad Radiol 10:620–630CrossRef

32.

Richardson MC, Bell G, Fullarton GM (1996) Incidence and nature of bile duct injuries following laparoscopic cholecystectomy: an audit of 5913 cases. West of Scotland Laparoscopic Cholecystectomy Audit Group. Br J Surg 83:1356–1360CrossRef

Title: Routine MRCP in the management of patients with gallbladder stones awaiting cholecystectomy: a single-centre experience
Authors: Valentina Virzì
Noemi Maria Giovanna Ognibene
Antonio Salvatore Sciortino
Glenda Culmone
Giuseppe Virzì
Publication date: 01-10-2018
Publisher: Springer Berlin Heidelberg
Published in: Insights into Imaging / Issue 5/2018
Electronic ISSN: 1869-4101
DOI: https://doi.org/10.1007/s13244-018-0640-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Routine MRCP in the management of patients with gallbladder stones awaiting cholecystectomy: a single-centre experience

Abstract

Objectives

Methods

Results

Conclusions

Main messages

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Main messages

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