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Comparative Evaluation of the Role of Ultrasonography & Magnetic Resonance Cholangiopancreatography in Obstructive Jaundice

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Comparative Evaluation of the Role of Ultrasonography & Magnetic Resonance Cholangiopancreatography in Obstructive Jaundice Volume : 5 | Issue : 11 | November-2016 ISSN - 2250-1991 | IF : 5.215 | IC Value : 77.65 Original Research Paper Gastroenterology Comparative Evaluation of the Role of Ultrasonography & Magnetic Resonance Cholangiopancreatography in Obstructive Jaundice Department of Radiodiagnosis and Imaging, M.M. Institute of Vibha Verma Medical Sciences and Research, Mullana (Distt -Ambala), India Department of Radiodiagnosis and Imaging, M.M. Institute of Harneet Narula Medical Sciences and Research, Mullana (Distt -Ambala), India Dept of gastroenterology, M.M. Institute of Medical Sciences and Kartar Singh Research, Mullana (Distt -Ambala), India Department of Radiodiagnosis and Imaging, M.M. Institute of Amit Mittal Medical Sciences and Research, Mullana (Distt -Ambala), India Department of Radiodiagnosis and Imaging, M.M. Institute of Samita singal Medical Sciences and Research, Mullana (Distt -Ambala), India Department of Surgery , M.M. Institute of Medical Sciences and Rikki Singal Research, Mullana (Distt -Ambala), India Aims and Objective: To evaluation the role of ultrasonography (USG) & magnetic resonance cholangiopancreatography (MRCP) in obstructive jaundice patients. This study assessed the USG & MRCP as useful diagnostic tool and then correlate the findings with operative / fine needle aspiration cytology (FNAC) / histopathological / therapeutic follow up whosever performed. Material and Methods: This is a prospective study performed on 35 patients (22 females and 13 males ) with an average age of 45 years presented with obstructive jaundice for whom USG and magnetic resonance imaging (MRI) and MRCP performed in the department of radiology in Maharishi Markandeshwar University, Mullana, Ambala. The final diagnosis was found by operative / FNAC / histopathological / ERCP findings. Results: The most common cause of obstructive jaundice in our study was choledocholithiasis (45.7%), followed by carcinoma pancreas and periampullary growth (17%), then benign strictures and mass at port (8.5% each), cholangiocarcinoma, carcinoma gall bladder and choledochal cyst (5.7% each) & finally pancreatitis (2.8%). In this study, ABSTRACT USG correctly defined the level and cause of obstruction only in 69% of total cases with a sensitivity of 69% and specificity of 100% in pancreaticobiliary diseases. MRI-MRCP correctly defined the level and cause of obstruction in all cases (100%), with the sensitivity and specificity of 100%. Conclusion: USG is a very useful screening modality to identify the dilated pancreaticobiliary ductal system & level and cause of obstruction. It is safe, simple, inexpensive, free from hazards of radiation exposure. However, MRCP along with conventional MR imaging is highly accurate in determining presence, level and cause of obstruction. After the ultrasonographic demonstration of a biliary tract dilatation, MRCP can be used as the first diagnostic modality to assess the diagnosis and to establish the indication for a surgical. KEYWORDS USG; MRCP; obstruction; bilary duct; jaundice; pancreatic duct Introduction- Material and methods – Choledocholithiasis and malignant bile duct obstruction are This study was conducted in the Department of Radiodiagno- the most common diseases that involve the biliary system, and sis in Maharishi Markandeshwar Institute of Medical Sciences pancreatitis and pancreatic carcinoma are the most common and Research, Mullana. 30 patients suffering from various dis- disorders of the pancreas.1Accurate methods of detecting eases of biliary tract and pancreas with obstructive jaundice of common bile duct and pancreatic disease in patients with ob- all age group and either sex were included in this study. All structive jaundice are important to both surgeons and endos- the patients with obstructive jaundice were included. The pa- copists for planning an effective interventional strategy and tients excluded from the study were – if metallic implants in therefore a need for less invasive, safe and highly sensitive di- situ, uncooperative patients, CBD stents, biliary bypass proce- agnostic procedure.2 Before the advent of radiology, clinicians dure done earlier. had to use their bed side skills and a few laboratory tests to predict the type of jaundice. In those days exploratory laparot- Thorough clinical history of the patients was taken. A general omy was the only way to confirm the diagnosis. Beck (1889) physical examination of all the patients was carried out along was the first to report a radiopaque calculus in gallbladder on with detailed per abdomen examination. Then USG was done pelvic X-ray abdomen.3 The incidence of opaque biliary calcu- in all patients on HD-6 (Philips Medical Systems) ultrasound li is about 20%. Thus, a preliminary plain film was of para- machine. Liver, gall bladder, biliary tract, pancreas & abdomen mount importance in cholecystography, since these calculi were scanned & the findings were recorded as per proforma were later obscured by the contrast filled gallbladder.4 attached. 28 | PARIPEX - INDIAN JOURNAL OF RESEARCH Volume : 5 | Issue : 11 | November-2016 ISSN - 2250-1991 | IF : 5.215 | IC Value : 77.65 On USG, Ist order IHBR were dilatedin29cases,2 IHBRwere On USG,Istorder (260units/l). (360units/l)and1ofpancreatitis creas pan ofcarcinoma ase wasraisedin3patients,2patientswere 16to1473 KAU.Serumamyl tients withvaluesrangingfrom 5 to585IU.Serumalkalinephosphatasewasraisedin28pa 531 IU.SGPTwasraisedin25caseswithvaluesrangingfrom 58to SGOT wasraisedin27caseswithvaluesrangingfrom 35 cases.distribution in shows the S.bilirubin 9 mg%. Table 5.1 was1.7to20.6mg% withameanof range inbenigngroup was11.8to22.2mg%withamean of16.2mg%.The group 1.7to22.2mg%.The rangeinmalignant level rangingfrom jaundice. Serumbilirubinwasraisedin33caseswith 3-6months.13patientsdidnot giveanyhistoryof dice from ration lessthan1monthand7patientswithdurationofjaun withdu dice above6months(37%).Only2patientspresented withdurationofjaun Maximum numberofpatientspresented confluent lymphnodalmass. case ofof age, a being 33 years youngest in malignant group, seen Manyyoungpatientswere 1 maleandfemaleinbenigngroup. and 4malesand8femalesinmalignantgroup were 56 years.There therangewas47-65yearswithameanofwhile inbenigngroup, was33-70yearswithameanof53.8 tients inmalignantgroup and 22femaleswithasexratiobeing0.59(13/22).Agerangeofpa 13males were than30yearsofage(94%).There more tients were est was77years.Themeanage50Majorityofthepa Results- erative /histopathologicalfindingsorclinicalfollowup. andevaluatedwithop compared MRI andUSGfindingswere and/or histopathologicalexamination,orclinicalfollow-up. indicated.Diagnosiswasfinallyconfirmedbysurgery wherever done cholangiogram were and postoperative T-tube through meal follow abdomen, barium x-ray view, chest x-ray PA like relevant investigations Other other associatedfindings,ifany. typeandextentofthedisease to evaluatethepresence, diseasefollowedbyMRCP per abdomenforpancreaticobiliary MRIoftheup subjectedtoroutine MRI: Allthecaseswere ated findings,ifany. typeandextentofthediseaseotherassoci the presence, evaluate tract to pancreaticobiliary particular attention to ing USG: USGexaminationofabdomenwasdoneinallcasespay withUSG&MRCPdiagnosis.formed) wascompared operative findings/ histopathology reports/ ERCP – wherever per reports/ ERCP–wherever operative findings/histopathology basisof followedupandthe final diagnosis(madeonthe were attached.Patients asperproforma recorded MRCP findingswere required. andcontrastMRIwasdonewherever pancreas theliverand obtainedthrough sequenceswere other relevant tation of images were used.AdditionalT tation ofimageswere dimentionaldisplayandro (MIP)algorithm.Three projection usingmaximumintensity reconstructed imageswere source signal.Afterobtainingthedata, ofbackground suppression technique wasalsodonetoobtainahomogenouscomplete Fat saturation artifacts. related to eliminate breathing added holdtechniqueswere duct.Breath iary radicalsandpancreatic portahepatis,intrahepaticbil dially soastoincludetheentire takenra and inthickslab(SshMRCP)techniqueimageswere planes oblique coronal and coronal in axial, taken were ages Fast spinechosequences.Inthinslab3D(HR)techniqueim SENSE bodyarraycoil.MRCPwasperformedusing2Dand3D formed ona1.5TAchieva(PhilipsMedicalSystem)using Magnetic ResonanceImaging(MRI)examinationwasper METHOD: were identifiedin13cases (casesno.4,5,8,9,11,13,14, 17,were OnUSG,gallstones samein USGandMRCP. es). Findingswere wasthecommonest cause(4cas pancreas .Carcinoma stricture included 3casesofcholedocholithiasis and2casesofbenign GB. Benigngroup and1casewascarcinoma cholangiocarcinoma 2caseswere pancreas, carcinoma lignant causes,4caseswere observed.Outof7ma 18, 23,29).Thefollowingpointswere 15, 16,7, 9, 10, no. 1, cholecystectomy (cases past history of a 9patientshad der wasvisualized26casesonUSG andMRCP. and 3 rd order in 3 cases. IHBR were normalin3cases.Gall blad in 3cases.IHBRwere order Age oftheyoungestpatientwas7yearswhilethatold 1 w andT nd 2 order in12 order weighted& - - - - - - - - - - - - - - - - - - - - - - 17.25mm and in benign group was13.14mm(table-1). 17.25mm andinbenigngroup wasin malignant group CBD diameter 14.37mm. The mean was maximum diameterofdilatedCBDfor27 casesin allcases.Mean due tocholedocholithiasiswhich was was seen in16cases, (FD) fillingdefect seen in13cases,allduetoCBDcalculi.OnMRCP, which wasnotvisualizedonUSG.OnUSG,fillingdefect(FD) onMRCP CBDwasdilatedanddistalpartnarrowed proximal no 1), involvingdistal CBD, (case stricture In 1 caseofbenign mal. distalpartwasnor CBDwasdilatedwhereas
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