Researchers from Charleston, South Carolina, USA, assessed the ability of magnetic resonance cholangiopancreatography (MRCP) to alter the differential diagnosis of suspected biliary and pancreatic disease. They also looked at whether MRCP could prevent diagnostic and/or therapeutic ERCP.
40 consecutive patients who were referred for ERCP underwent clinic evaluation, followed by MRCP and then ERCP.
Patients presented with the following clinical conditions: jaundice (19.7%), abnormal liver enzymes (42.6%), abdominal pain (11.5%), recurrent acute pancreatitis (11.5%), and suspected complications of chronic pancreatitis (14.7%).
In Phase 1, the number of differential diagnoses and the perceived need for diagnostic ERCP were evaluated. This was performed after each step, by the endoscopist who conducted the ERCP.
|Value of MRCP limited by:|
- patient selection
- physician's specialty
|American Journal of Gastroenterology|
In Phase 2, the process was repeated after presenting clinical information and MRCP results to different individual physicians: another endoscopist, a hepatologist, a radiologist, and a surgeon. All were blinded to the ERCP results.
The researchers found that in Phase 1, adding MRCP information to diagnostic ERCP information did not change the mean number of differential diagnoses significantly. In addition, it prevented no therapeutic ERCP.
In Phase 2, adding MRCP to clinical information only (without ERCP) reduced the differential diagnosis significantly for the radiologist and the surgeon only. The team calculated that it would have prevented less than 3% of diagnostic and therapeutic ERCPs for all physicians.
Dr Anand V. Sahai, of the Medical University of South Carolina, concluded on behalf of colleagues, "The value of MRCP may be limited if patient selection is inappropriate and may also differ according to the physician's specialty."
In an accompanying editorial, Adamek and Riemann, of Ludwigshafen, Germany, write, "The aim of this present study is of clear importance, especially in the light of a lack of good data.
"However, it is hardly surprising that the value of MRCP may be limited in patients referred to tertiary centers, because these patients will frequently require advanced diagnosis and therapy.
"Gastroenterologists are urged to contribute their endoscopic and ultrasound expertise for the future development of virtual imaging," they conclude.