A retrospective evaluation of pancreatobiliary disease: Comparison between MR colangiopancreatography (MRCP) with endoscopic retrograde colangiopancreatography (ERCP)

Purpose: To verify the diagnostic capability of MRCP in comparison to ERCP in the detection of pancreatobiliary disease. Materials and methods: 93 patients with pancreatobiliary disorders were retrospectively evaluated comparing MRCP with ERCP. The MR study was carried on employing a 1.5 T unit (GE Signa Horizon) using a fat-sat breath-hold thin-slab and thick-slab single-shot T2-w sequences on coronal plane. Axial T1 and T2-w sequences were previously obtained. ERCP was performed within 2 days and considered as gold standard in association with clinical history, interventional and surgical procedures. Results: Sensitivity, specificity and diagnostic accuracy was determined for both techniques. MRCP revealed the following findings: 3 case of colangiocarcinoma, 54 coledocholithiasis, 5 biliar detritis, 3 anatomical variant of coledocho and cistic ducts, 2 iatrogenic stenosis, 2 external stenosis, 3 ampulloma, 12 pancreas carcinoma, 3 acute pancreatitis and 7 cases of no pathological evidence. MRCP mistakes regarded 1 case of pancreatitis erroneously evaluated as pancreas carcinoma and 1 case of ampulloma considered small papillary stone. Sensitivity, specificity and diagnostic accuracy of MRCP in the evaluation of malignant disease was the following: 87.5, 100 and 91.6 %, and was equivalent to ERCP if considered alone. For the benignant disease MRCP showed sensitivity, specificity and diagnostic accuracy values (81.8, 100 and 84.6 %) slightly lower than ERCP alone (90.9, 100 and 92.3 %). Conclusion: On the basis of our experience we postulate MRCP, combined with conventional MRI, a worthy diagnostic mean able to discriminate the patients candidate to an endoscopic treatment and to influence the therapeutic options.