Recent Concept in Imaging of Cholestasis
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Objective: This study was conducted in an attempt to demonstrate the clinical applications and emphasizing the role of MRCP in the assessment of the obstructive cholestasis. Patients and Methods: 25 patients were studied, all were subjected to clinical exmination and laboratory investigations. MRCP was done using 2D FSE sequence with respiratory trigering and fat suppression. Ultrasonography, CT, ERCP were also carried out. The patients in this study were classified into 5 groups according to their pathological nature: Group I neoplastic, II calcular. Ill inflammatory. IV binary cystic diseases and group IV iatrogenic. Results: MRCP was able to identify the presence of obstruction and correct depicts its level in all cases and also define the extent of the neoplasm through the associated conventional images. In inflammatory strictures it gives accurate mapping of the biliary tree, demonstrating the smooth tapering stricture in addition to the dilated beaded pancreatic duct in chronic pancreatitis. In biliary cystic disease it proved that MRCP is very rapidly evolving as it provides images indentical to ERCP without invasiveness or ionizing radiation. In cases of iatrogenic biliary stenosis. MRCP showed the dilated ducts above, the site of ligature with the lack of segment from the decompressed CBD below the ligature. We found that MRCP is of great value over ERCP in patients who had a prior enterobiliary anastomosis beyond thc duodenum. Conclusion: MRCP is evolving as a non invasine, rapid and accurate modality to evaluate the bilio-pancreatic system that can provide diagnostic information comparable to those obtained by the gold standard invasive techniques. also the standard cross sectional MR images provide additional information regarding the character and staging of the obstruction. Thus MRCP will modify the approach of these patients in the near future, that is it can totally replace the diagnostic role of ERCP and staging role of CT. Key words: Cholestasis - MRCP.