Correlation between MRCP and ERCP findings at a tertiary care hospital.

BACKGROUND: It is common clinical practice to obtain Magnetic Resonance Cholangiopancreatography (MRCP) prior to Endoscopic Retrograde Cholangiopancreatography (ERCP) to evaluate the biliary system. With recent improvements of MRCP, it is important to correlate the findings of these two studies. AIM: To examine the correlation between MRCP and ERCP findings in patients at a tertiary care hospital. METHODS: A total of 165 patients were identified who underwent MRCP prior to ERCP at West Virginia University between July 1, 2004 and June 30, 2006 (98 females and 67 males). Patients' demographic information and their laboratory values and diagnostic study outcomes prior to procedure were collected, entered into MS Access, and analyzed using SAS 10.0. Sensitivity, specificity, positive predictive value and negative predictive value were calculated. Two-tailed p-values of <= 0.05 were considered statistically significant. RESULTS: Baseline demographic characteristics were comparable between male and female patients. Hepatobiliary and pancreatic duct results were grouped together. MRCP was 74.6% sensitive and 83.5% specific for choledocholithiasis, 85.4% sensitive and 87.4% specific for strictures, 85.9% sensitive and 91.2% specific for obstruction, 92.4% sensitive and 93.5% specific for ductal dilatation, and 90.8% sensitive and 92.6% specific for detection of periductal masses. MRCP appeared to have more false negative results for choledocholithiasis and strictures and more false positive results for ductal dilatation and periductal mass detection compared with ERCP. CONCLUSIONS: In patients with presentations suggestive of hepatobiliary and pancreatic disease, despite recent improvements in MRCP technique, the sensitivity and specificity of MRCP is still not close enough to that of ERCP for detection of choledocholithiasis, hepatobiliary and pancreatic ductal dilatation, periductal masses, or obstruction to be used as a substitute. Thus, ERCP remains the gold standard for visualization of the hepatobiliary and pancreatic tree.