Kuldeepsinh D. Mori1 , Rishi V. Patel2
BACKGROUND Sonography has limitations especially in the evaluation of the distal CBD which may be obscured by bowel gas and demonstration of biliary strictures. CT has a low sensitivity for detecting biliary stones which have high cholesterol content and they may be missed as their attenuation is same as bile. Biliary strictures are not directly visualized on CT. The length and extent of the stricture is difficult to determine on CT. ERCP has a morbidity rate of 7%, (post procedures pancreatitis, sepsis, bleeding and gastro-duodenal perforation). A mortality rate of 1% is reported and unsuccessful cannulations in 3-9%. In view of the limitations of ultrasound/CT scan, the invasiveness and complications of ERCP, MRCP was developed and is now assuming the position of the modality of choice in evaluation of the biliary tree after initial USG. METHODS During the period August 2010 - September 2012, a prospective study of 75 patients was carried out. MRI examinations were performed using 1.5 Tesla MR scanner (GE HDXT-8 channels) using torso-array surface coil. RESULTS Out of 75 examinations performed, malignant bile duct stricture was the most common pathology. Out of 21 patients, choledochal cyst was the most common, present in 13 patients. Iatrogenic bile duct injury is the most common cause of benign stricture in this study accounting for 9 out of 19 patients. Cholangiocarcinoma is the most common cause of malignant stricture. CONCLUSIONS Choledochal cyst is most common in the age group of 0-10 years. Choledochal cyst is more common in female than male. Type 1 Choledochal cyst is the most common type followed by type 4A. 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. Hilar cholangiocarcinoma is the most common type of the cholangiocarcinoma. MRCP is less time consuming than ERCP. MRCP can visualise the status of the biliary apparatus proximal to the complete stricture, which is not feasible on ERCP. MRCP is useful when ERCP fails or it is incomplete.
