The value of magnetic resonance cholangiopancreatography in obstructive jaundice. A retrospective and prospective study at Kenyatta National Hospital
Introduction: Diseases of the hepatobiliary tree are common all over the world and recently developed magnetic resonance imaging techniques are increasingly finding application in the evaluation of biliary and pancreatic diseases. Magnetic resonance cholangio-pancreatography (MRCP) has high spatial resolution and is used for rapid noninvasive and accurate imaging of the pancreaticobiliary tree. The objective of this study was to determine the ability of MRCP examination to accurately determine the site and etiology of biliary obstruction. Methods: This cross-sectional study was designed to include former and current patients with clinical features of obstructive jaundice who subsequently underwent MRCP and definitive surgery over a 12 month period. Patients were mainly recruited from the surgical (liver) clinic at Kenyatta National Hospital. The methods involved comparative review ofMRCP images as well as comparison between MRCP- and surgery-based diagnoses. The sensitivity of MRCP-based diagnosis was also determined. Statistical analysis was conducted using SPSS and involved both descriptive and inferential analysis. The chi-square test was mainly used for inferential analysis comparing cross tabulations for MRCP findings versus patient characteristics. Results: Seventy-three (n = 73) patients with obstructive jaundice of whom 56.2% (41) were female participated in the study. The sample predominantly comprised adult patients with a mean age of53.3 years (SD 17.9). MRCP was done, either alone or in combination with other imaging studies in 96% of patients. The most common sites of obstruction visualized on MRCP were the distal CBD (38.6%) and proximal CBD (34.3%). The leading causes of obstruction were tumors (53%), followed by calculi (20%) and strictures (17%). MRCP had high sensitivity for surgery confirmed diagnoses with sensitivities of 93.9%, 92% and 92% for tumor, calculi and stricture diagnoses confirmed by surgery. Conclusions: MRCP has a high diagnostic accuracy in evaluating patients with obstructive jaundice. Therefore MRCP can be considered a valuable alternative to diagnostic ERCP. Further studies are required to determine the feasibility of using this method routinely in the diagnosis of obstructive jaundice in low income countries including Kenya.