Diagnostic accuracy of MRCP in biliary and pancreatic duct pathologies with ERCP as gold standard

Abstract

Background: Magnetic Resonance Cholangiopancreatography (MRCP) is a non-invasive imaging modality used for evaluating biliary and pancreatic ductal pathologies. Endoscopic Retrograde Cholangiopancreatography (ERCP), although considered the gold standard for these evaluations, is associated with significant risks, including pancreatitis and bleeding.

Methods: 

This retrospective observational study involved 246 patients with suspected biliary or pancreatic duct pathologies presented to Radiology department of Shifa International Hospital, Islamabad from January 2018 till September 2022. Frequencies and percentages were used for categorical data while continuous data was represented as mean and standard deviation. The following metrics of diagnostic accuracy were computed: sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) using Med Calc software. 

Results:

Mean age group was 52.37 years. The most common pathologies identified were benign biliary strictures and choledocholithiasis (45.5 % and 27.6 %). Less common pathologies were malignant biliary strictures, pancreatic duct strictures/stones, and congenital CBD abnormality like choledochal cyst. MRCP demonstrated sensitivity of 84 % and specificity of 92% for Choledocholithiasis, sensitivity of 92 % and specificity of 77% in detecting benign biliary strictures, sensitivity of 67 % and specificity of 100% in detecting malignant biliary strictures, sensitivity of 100 % and specificity of 99%in detecting pancreatic duct pathologies, sensitivity of 16 %specificity of 99%  in detecting congenital CBD anomalies.  

Conclusion: MRCP is a reliable and accurate non-invasive imaging modality for diagnosing biliary and pancreatic ductal pathologies, showing a high degree of concordance with ERCP.

Keywords: MRCP, ERCP, biliary pathologies, pancreatic duct pathologies, diagnostic accuracy, sensitivity, specificity.