Varghese JC, Farrell MA, Courtney G, Osborne H, Murray FE, Lee MJ. Role of MR cholangiopancreatography in patients with failed or inadequate ERCP. AJR Am J Roentgenol 1999 Dec;173(6):1527-33
Department of Radiology, Beaumont Hospital, Dublin, Ireland.
OBJECTIVE: The purpose
of our study was to evaluate the usefulness of MR cholangiopancreatography
in the diagnosis and further treatment of patients with failed
or inadequate ERCP. SUBJECTS AND METHODS: Fifty-eight patients
with failed or inadequate ERCP underwent MR cholangiopancreatography
using a two-dimensional heavily T2-weighted multislice fast spin-echo
technique. The final diagnosis was made on the basis of a second
ERCP (n = 4), percutaneous transhepatic cholangiopancreatography
(n = 19), intraoperative cholangiography (n = 6), percutaneous
biopsy (n = 3), surgical findings (n = 5), or clinical follow-up
(n = 21) for a mean period of 22 months (range, 7-31 months).
RESULTS: MR cholangiopancreatography was technically successful
in 57 patients and resulted in a sensitivity, specificity, and
diagnostic accuracy of 97.1%, 100%, and 98.2%, respectively. Overall,
MR cholangiopancreatography gave clinically useful information
that contributed to patient management in 56 (96.6%) of the 58
patients. On the basis of the MR cholangiopancreatography findings,
patients were managed using a second ERCP (n = 4), combined percutaneous
and endoscopic procedure (n = 2), percutaneous biliary stent insertion
(n = 13), surgery (n = 12), chemotherapy (n = 1), or conservative
treatment (n = 24). CONCLUSION: MR cholangiopancreatography was
found to have a unique and valuable role in the investigation
of patients in whom ERCP failed or was inadequate. MR cholangiopancreatography
helped us avoid using invasive procedures such as percutaneous
transhepatic cholangiography in the diagnosis of bile duct disease
after failed ERCP.
| Texte |