Top

Surgical Endoscopy

Published in:

01-08-2005 | Original article

Short-versus long-sequence MRI cholangiography for the preoperative imaging of the common bile duct in patients with cholecystolithiasis

Authors: A. Shamiyeh, E. Lindner, J. Danis, K. Schwarzenlander, W. Wayand

Published in: Surgical Endoscopy | Issue 8/2005

Abstract

Background

This study aimed to compare an 18-s fast spin echo magnetic resonance image sequence (coronal thick-section two-dimensional breathhold) with a three-dimensional axial and coronal thin-section sequence and its secondary reconstruction, and to assess its value in the diagnosis of bile duct pathologies, particularly common bile duct stones (CBDS) before laparoscopic cholecystectomy.

Methods

This study prospectively included 72 patients. Because of protocol violations, 14 of these patients had to be excluded. Thus, 58 patients (29 Man and 29 women with a mean age of 51 years) who had cholecystolithiasis or suspected choledocholithiasis were evaluated. Magnetic resonance cholangiopancreatography (MRCP) was performed for all patients with a fast sequence (18 s) and a long sequence (coronal oblique and axial respiratory triggered; 16 min). Two radiologists, blinded with respect to diagnosis, evaluated all the radiographic images. The MRCP results were confirmed for all the patients: 20 by endoscopic retrograde cholangiopancreatography, 46 by intraoperative cholangiography, and 2 by percutaneous transhepatic cholangiography.

Results

According to the findings, 16 patients (28%) had CBDS, 6 patients (10%) had common bile duct stenosis, and 36 patients (62%) had a clear bile duct. With regard to CBDS, the short sequence had 100% specificity, 94% sensitivity, and an overall accuracy of 98%. Its negative predictive value was 98%, and its positive predictive value was 100%. The long sequence had a specificity of 100% and a sensitivity of 100%.

Conclusion

Because of its high sensitivity and specifity, MRCP has the potential to be the diagnostic method of choice for CBD evaluation. The short sequence is not suitable for the diagnosis of all CBD pathologies, but in cases of suspected CBDS, more than 80% of the patients could be diagnosed correctly, and the complete sequence could be dropped.

Arguedas MR, Dupont AW, Wilcox CM (2001) Where do ERCP, endoscopic ultrasound, magnetic resonance cholangiopancreatography, and intraoperative cholangiography fit in the management of acute biliary pancreatitis? A decision analysis model. Am J Gastroenterol 96: 2892–2899CrossRefPubMed

Collins C, Maguire D, Ireland A, Fitzgerald E, O’Sullivan GC (2004) A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann Surg. 239: 28–33CrossRefPubMed

Cova M, Stacul F, Cester G, Ukmar M, Pozzi Mucelli R (2003) MR cholangiopancreatography: comparison of 2D single-shot fast spin-echo and 3D fast spin-echo sequences. Radiol Med 106: 178–109

Cuschieri A, Lezoche E, Morino M, Croce E, Lacy A, Toouli J, Faggioni A, Ribeiro VM, Jakimowicz J, Visa J, Hanna GB (1999) E.A.E.S. multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi. Surg Endosc 13: 952–957CrossRefPubMed

Demartines N, Eisner L, Schnabel K, Fried R, Zuber M, Harder F (2000) Evaluation of magnetic resonance cholangiography in the management of bile duct stones. Arch Surg 135: 148–152CrossRefPubMed

Deviere J, Matos C, Cremer M (1999) The impact of magnetic resonance cholangiopancreatography on ERCP. Gastrointest Endosc 50: 136–140PubMed

Ernst O, Asselah T, el Fakir Y, Mizrahi D, Carpentier F, L’Hermine C (1997) MR cholangiopancreatography. Ann Chir 51: 1111–1114PubMed

Fernandez M, Csendes A, Yarmuch J, Diaz H, Silva J (2003) Management of common bile duct stones: the state of the art in 2000. Int Surg. 88: 159–163PubMed

Fitzgibbons RJ Jr, Gardner GC (2001) Laparoscopic surgery and the common bile duct. World J Surg 25: 1317–1324CrossRefPubMed

10.

Fulcher AS, Turner MA (1998) Pitfalls of MR cholangiopancreatography (MRCP). J Comput Assist Tomogr) 22: 845–850CrossRef

11.

Kim JH, Kim MJ, Park SI, Chung JJ, Song SY, Kim KS, Yoo HS, Lee JT, Kim KW ( 2002) MR cholangiography in symptomatic gallstones: diagnostic accuracy according to clinical risk group. Radiology 224: 410–416PubMed

12.

Laokpessi A, Bouillet P, Sautereau D, Cessot F, Desport JC, Le Sidaner A, Pillegand B (2001) Value of magnetic resonance cholangiography in the preoperative diagnosis of common bile duct stones. Am J Gastroenterol 96: 2354–2359CrossRefPubMed

13.

Leuschner U, Seifert E (1991) The role of endoscopy in the treatment of gallstones. In: Speranza V, Barbara L (eds). Changing concepts in biliary stone management and Nyhus LM (ed) Problems in general Surgery. JB Lippincott, Philadelphia pp 617–627

14.

Liu T, Consorti E, Kawashima A (1999) The efficacy of magentic resonance cholangiography for the evaluation of patients with suspected choledocholithiasis before laparoscoic cholecystectomy Am J Surg 178: 480–484

15.

Macaulay SE, Schulte SJ, Sekijima JH, Obregon RG, Simon HE, Rohrmann CA Jr, Freeny PC, Schmiedl UP (1995) Evaluation of a non-breathhold MR cholangiography technique. Radiology 196: 227–232PubMed

16.

Menon K, Barkun AN, Romagnuolo J, Friedman G, Mehta SN, Reinhold C, Bret PM (2001) Patient satisfaction after MRCP and ERCP. Am J Gastroenterol 96: 2646–2650CrossRefPubMed

17.

Mitchell SA, Jacyna MR, Chadwick S (1993) Common bile duct stones: a controversy revisited. Br J Surg 80: 759–760PubMed

18.

Park AE, Mastrangelo MJ (2000) Endoscopic retrograde cholangiopancreaticography in the management of choledocholithiasis. Surg Endosc 14: 219–226CrossRefPubMed

19.

Pereira-Lima JC, Rynkowski CB, Rhoden EL (2001) Endoscopic treatment of choledocholithiasis in the era of laparoscopic cholecystectomy: prospective analysis of 386 patients. Hepatogastroenterology 48: 1271–1274PubMed

20.

Rieger R, Wayand W (1995) Yield of prospective, noninvasive evaluation of the common bile duct combined with selective ERCP/sphincterotomy in 1,390 consecutive laparoscopic cholecystectomy patients. Gastrointest Endosc 42: 6–12PubMed

21.

Rosch T, Meining A, Fruhmorgen S, Zillinger C, Schusdziarra V, Hellerhoff K, Classen M, Helmberger H (2002) A prospective comparison of the diagnostic accuracy of ERCP, MRCP, CT, and EUS in biliary strictures. Gastrointest Endosc 55: 870–876CrossRefPubMed

22.

Sarli L, Costi R, Gobbi S, Iusco D, Sgobba G, Roncoroni L (2003) Scoring system topredict asymptomatic choledocholithiasis before laparoscopic cholecystectomy Surg Endosc 17: 1396–1403CrossRefPubMed

23.

Sarli L, Pietra N, Franze A, Colla G, Costi R, Gobbi S, Trivelli M (1999) Routine intravenous cholangiography, selective ERCP, and endoscopic treatment of bile duct stones before laparoscopic cholecystectomy. Gastrointest Endosc 50: 200–208PubMed

24.

Scheiman JM, Carlos RC, Barnett JL, Elta GH, Nostrant TT, Chey WD, Francis IR, Nandi PS (2001) Can endoscopic ultrasound or magnetic resonance cholangiopancreatography replace ERCP in patients with suspected biliary disease? A prospective trial and cost analysis. Am J Gastroenterol 10: 2900–2904CrossRef

25.

Shamiyeh A, Rieger R, Schrenk P, Lindner E, Wayand W (2001) Spiral CT cholangiography is not suitable for routine diagnosis before laparoscopic cholecystectomy. Chirurg 72: 159–163CrossRefPubMed

26.

Sharma SK, Larson KA, Adler Z, Goldfarb MA (2003) Role of endoscopic retrograde cholangiopancreatography in the management of suspected choledocholithiasis. Surg Endosc 17: 868–871CrossRefPubMed

27.

Soto JA, Barish MA, Yucel EK, Ferrucci JT (1995) MR cholangiopancreatography: findings on 3D fast spin-echo imaging. AJR Am J Roentgenol 165: 1397–1401PubMed

28.

Sungler P, Holzinger J, Heinerman PM, Waclawiczek HW, Boeckl O (1997) Preoperative therapeutic splitting. Zentralbl Chir 122: 1083–1087PubMed

29.

Zidi SH, Prat F, Le Guen O, Rondeau Y, Rocher L, Fritsch J, Choury AD, Pelletier G (1999) Use of magnetic resonance cholangiography in the diagnosis of choledocholithiasis: prospective comparison with a reference imaging method. Gut 44: 118–122PubMed

Title: Short-versus long-sequence MRI cholangiography for the preoperative imaging of the common bile duct in patients with cholecystolithiasis
Authors: A. Shamiyeh
E. Lindner
J. Danis
K. Schwarzenlander
W. Wayand
Publication date: 01-08-2005
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 8/2005
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-004-2167-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Short-versus long-sequence MRI cholangiography for the preoperative imaging of the common bile duct in patients with cholecystolithiasis

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 8/2005

Laparoscopic Resection Of Congenital Choledochal Cyst, Choledochojejunostomy, and extraabdominal Roux-en-Y anastomosis

Laparoscopic resection of gastric gastrointestinal stromal tumors

Laparoscopic nephrectomy for unilateral multicystic dysplastic kidney in children

Ergonomics and human factors in endoscopic surgery: a comparison of manual vs telerobotic simulation systems

Endoscopic adrenalectomy for pheochromocytoma: difference between the transperitoneal and retroperitoneal approaches in terms of the operative course

Vacuum-assisted abdominal wall lift for minimal-access surgery: a porcine model study