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. |
