Abstract

Aim: To compare the diagnostic accuracy of Magnetic Resonance Cholangiopancreatography
(MRCP) with Ultrasound and Computed Tomography (CT) in evaluation of patients with
obstructive jaundice.
Methodology: This study was conducted in the Department of Radio Diagnosis, Maharishi
Markandeshwar Medical College and Hospital, Kumarhatti, Solan for the period of 6 months.
60 patients clinically diagnosed as suffering from obstructive jaundice and having total
Bilirubin greater than 5mg/dl were included in this study. Patients who were pregnant and
claustrophobic were not included in this study. All the patients were instructed to fast
overnight prior to examination. Renal functional status, clinical history of all the patients was
noted before undergoing contrast CT. All the patients in the study underwent USG
examination first followed by MRCP and finally CT. Both curvilinear and linear probes were
used in the study. Images of the biliary tree were recorded for later review. Helical CT was
performed on a Philips Healthcare 128 slice CT scanner. MRCP was performed on Philips
Healthcare 1.5 Tesla MRI Scanner. All images were obtained with breath holding and
parameters were individualized.
Results: Of 60 patients, 16 (26.7%) patients were ≤45 years and 44 (73.3%) were >45 years.
32 (53.3%) cases were males and 28 (46.7%) were females. There were 37 (61.7%) patients
with ≤40 days of duration of symptoms and 23 (38.3%) patients with >40 days of duration of
symptoms. In causes of obstruction, choledocholothiasis was responsible
for19(31.7%),stricture16(26.7%),carcinoma ofheadofpancreas11(18.3%),
gallbladdercarcinoma6 (10%), periampullary carcinoma5(8.3%) and cholangiocarcinoma in 3
(5%) of the cases. Taking MRCP as gold standard, 100% (60 cases) had obstructive jaundice.
Whereas 56.7% (34 cases) were diagnosed correctly using USG and 86.7% (52 cases) were
diagnosed correctly using CT. The sensitivity of MRCP is 94% and CT is 92%, while it is
100% for USG. Inspite of the high sensitivity for USG, the specificity for the same is very
low at 70% when compared to that of CT’s 72% and MRCP’s 100%.
Conclusion: The only drawback of MRCP is the cost involved and the availability. From this
study, It is recommended that helical CT can be used as a screening imaging technique to
identify the presence or absence of intrahepatic biliary duct dilatation; thereby shortlisting the
patients for MRCP examination.