Reena Mathur, Avinash Gupta, Kalpana Manral, Prama Dubey, Devraj Yadav, Shashi Meena
BACKGROUND Hepatobiliary system diseases are a common pathology encountered in clinical practice. Ultrasound, Computed Tomography (CT), and Endoscopic Retrograde Cholangiopancreatography (ERCP) and Magnetic Resonance Cholangiopancreatography (MRCP) are the commonly used imaging modalities to evaluate the same. MRCP provides high resolution projection images of the biliary tree and pancreatic duct without being invasive. We wanted to evaluate MRCP appearance of various hepatobiliary lesions and identify the aetiology of benign and malignant strictures. METHODS This is a descriptive study. The study group consisted of 108 patients diagnosed or suspected of having hepatobiliary lesions referred for MRI. RESULTS Malignant stricture of the bile duct was the most common pathology in this study comprising 35 patients followed by benign strictures comprising 27 patients. A total of 30 patients of choledochal cyst was seen, the most common being type 1 Choledochal cyst. 18 patients of choledocholithiasis were seen. A total of 27 patients of benign stricture were seen. Iatrogenic injury was the most common cause of the bile duct stricture followed by stricture associated with chronic pancreatitis in 2 patients. There were 35 patients of malignant stricture in this study. Most common cause of malignant stricture was cholangiocarcinoma. MRCP examination in patients of hepaticojejunostomy with operative site stricture showed stricture at the site of anastomoses. In these patients ERCP was not possible due to unfavourable anatomy. MRCP shows ductal dilatation proximal to stricture in patients of hilar cholangiocarcinoma which was not possible on ERCP in these two patients due to tight stricture. MRCP examined bile duct in physiological state without the problem of the overestimation of the size of the bile ducts. CONCLUSIONS MRCP does not involve ionising radiation, contrast media and is totally non-invasive. Malignant stricture comprises commonest disease, followed by benign stricture of bile duct and choledochal cysts. MRCP is of advantage when distal CBD calculi are obscured by gas on USG. Iatrogenic injury is the most common cause of the benign bile duct stricture.
