Skip to main content
SpringerLink
Log in

Choledocholithiasis: repetitive thick-slab single-shot projection magnetic resonance cholangiopancreaticography versus endoscopic ultrasonography

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

This prospective study compares repetitive thick-slab single-shot projection magnetic resonance cholangiopancreatography (MRCP) with endoscopic ultrasonography (EUS) for the detection of choledocholithiasis. Fifty-seven consecutive patients (36 women, mean age 61) referred for suspected choledocholithiasis underwent MRCP, followed by EUS. Each procedure was performed by different operators blinded to the results of the other investigation. MR technique included a turbo spin-echo T2-weighted axial sequence with selective fat saturation (SPIR/TSE, TE=70 ms, TR=1,600 ms), followed by coronal dynamic MRCP. The same thick-slab slice was sequentially acquired 12 times as breath-hold single-shot projection imaging (SSh, TE=900 ms, TE=8,000 ms) centred on the common bile duct (CBD). Two experienced radiologists independently and blindly evaluated MR images for the detection of CBD stones. Their inter-observer agreement kappa was determined. Secondly, the two observers read MR images in consensus again. CBD stones were demonstrated in 18 out of 57 patients (31.6 %) and confirmed by endoscopic retrograde cholangiography (ERCP, n=17) or intraoperative cholangiography (n=1). Clinical follow-up served as the “gold standard” in patients with negative results without following invasive procedure (n=28). Sensitivity, specificity, accuracy, positive and negative predictive value for MRCP resulting from consensus reading were 94.9%, 94.4%, 94.7%, 97.4% and 89.5%, respectively. Corresponding values of EUS were 97.4%, 94.4%, 96.5%, 97.4% and 94.4%. Inter-observer agreement kappa was 0.81. Repetitive thick-slab single-shot projection MRCP is an accurate non-invasive imaging modality for suspected choledocholithiasis and should be increasingly used to select those patients who require a subsequent therapeutic procedure, namely ERCP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4a, b
Fig. 5
Fig. 6a, b

Similar content being viewed by others

References

  1. Hermann RE (1989) The spectrum of biliary stone disease. Am J Surg 158:171–173

    Article  PubMed  CAS  Google Scholar 

  2. Cohen SA, Siegel JH, Kasmin FE (1996) Complications of diagnostic and therapeutic ERCP. Abdominal Imaging 21:385–394

    Article  PubMed  CAS  Google Scholar 

  3. Loperfido S, Angelini G, Benedetti G, Chilovi F, Costan F, de Berardinis F, de Bernardin M, Ederle A, Fina P, Fratton A (1998) Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastroint Endosc 48:1–10

    Article  CAS  Google Scholar 

  4. Rieger R, Wayand W (1995) Yield of prospective, non-invasive evaluation of the common bile duct combined with selective ERCP/sphincterotomy in 1930 consecutive laparoscopic cholecystectomy patients. Gastrointest Endosc 42:6–12

    Article  PubMed  CAS  Google Scholar 

  5. Palazzo L, Girollet PP, Salmeron M et al (1995) Value of endoscopic ultrasonography in the diagnosis of common bile duct stones: comparison with surgical exploration and ERCP. Gastrointest Endoscop 42:225–231

    Article  CAS  Google Scholar 

  6. De Lédinghen V, Lecesne R, Raymon J-M et al (1999) Diagnosis of choledocholithiasis: EUS or magnetic resonance cholangiography? A prospective controlled study. Gastroint Endosc 49:26–31

    Article  Google Scholar 

  7. Buscarini E, Buscarini L (1999) The role of endosonography in the diagnosis of choledocholithiasis. Eur J Ultrasound 10:117–125

    Article  PubMed  CAS  Google Scholar 

  8. Amouyal P, Amouyal G, Levy P, Tuzet S, Palazzo L, Vilgrain V, Gayet B, Belghiti J, Fekete F, Bernades P (1994) Diagnosis of choledocholithiasis by endoscopic ultrasonography. Gastroenterology 106:1062–1067

    PubMed  CAS  Google Scholar 

  9. Scheiman JM, Ruth MM, Barnett JL, Elta GH, Nostrant TT, Chey WD, Francis IR, Nandi PS (2001) Can endoscopic ultrasound or magnetic resonance cholangiopancreatography replace ERCP in patients with suspected biliary disease? Am J Gastroenterol 96:2900–2904

    Article  PubMed  CAS  Google Scholar 

  10. Kondo S, Isayam H, Akahane M et al (2005) Detection of common bile duct stones: comparison between endoscopic ultrasonography, magnetic resonance cholangiography, and helical-computed-tomographic cholangiography. Eur J Radiol 271–275

  11. Prat F, Amouyal G, Amouyal P et al (1996) Prospective controlled study study of endoscopic ultrasonography and endoscopic retrograde cholangiography in patients with suspected common biled duct lithiasis. Lancet 347:75–79

    Article  PubMed  CAS  Google Scholar 

  12. Aubé C, Delorme B, Yzet T, Burtin P, Lebigot J, Pessaux P, Gondry-Jouet C, Boyer J, Caron C (2005) MR cholangiopancreatography versus endoscopic sonography in suspected common bile duct lithiasis: a prospective, comparative study. AJR Am J Roentgenol 184:55–62

    PubMed  Google Scholar 

  13. Materne R, Van Beers BE, Gigot JF, Jamart J, Geubel A, Pringot J, Deprez P (2000) Extrahepatic biliary obstruction: magnetic resonance imaging compared with endoscopic ultrasonography. Endoscopy 32:3–9

    Article  PubMed  CAS  Google Scholar 

  14. Deprez P (2000) Approach of suspected common bile duct stones: endoscopic ultrasonography. Acta Gastroenterol Belg 63:295–298

    PubMed  CAS  Google Scholar 

  15. Vitellas KM, Keogan MT, Spritzer CE, Nelson RD (2000) MR cholangiopancreatography of bile and pancreatic duct abnormalities with emphasis on the single-shot fast spin-echo technique. RadioGraphics 20:939–957

    PubMed  CAS  Google Scholar 

  16. Becker CD, Grossholz M, Becker M, Mentha G, de Peyer R, Terrier F (1997) Choledocholithiasis and bile duct stenosis: diagnostic accuracy of MR cholangiopancreatography. Radiology 205:523–530

    PubMed  CAS  Google Scholar 

  17. Ernst O, Calvo M, Serent G, Mizrahi D, Carpentier F (1997) Breath-hold MR cholangiopancreatography using a HASTE sequence: comparison of single-slice and multislice acquisition techniques. AJR Am J Roentgenol 169:1304–1306

    PubMed  CAS  Google Scholar 

  18. Guibaud L, Bret PM, Reinhold C, Atri M, Barkun AN (1995) Bile duct obstruction and choledocholithiasis: diagnosis with MR cholangiography. Radiology 197:109–115

    PubMed  CAS  Google Scholar 

  19. Soto JA, Barish MA, Alvarez O, Medina S (2000) Detection of choledocholithiasis with MR cholangiography: comparison of three-dimensional fast spin-echo and single-and multisection half-fourier rapid acquisition with relaxation enhancement sequences. Radiology 215:737–745

    PubMed  CAS  Google Scholar 

  20. Varghese JC, Liddell RP, Farrell MA, Murray FE, Osborne DH, Lee MJ (2000) Diagnostic accuracy of magnetic resonance cholangiopancreatography and ultrasound compared with direct cholangiography in the detection of choldocholithiasis. Clin Radiol 55:25–35

    Article  PubMed  CAS  Google Scholar 

  21. Pamos S, Benage A, Médina E, Martinez Sanjuan V (2003) Prospective evaluation of magnetic resonance cholangiopancreatography in patients with biliary disease: comparative study with conventional ultrasonography and endoscopic retrograde cholangiopancreatography. Dig Liv Dis 35:186–192

    Article  CAS  Google Scholar 

  22. Reinhold C, Taourel P, Bret PM, Cortas GA, Mehta SN, Barkun AN, Wang L, Tafazoli F (1998) Choledocholithiasis: Evaluation of MR cholangiography for diagnosis. Radiology 209:435–442

    PubMed  CAS  Google Scholar 

  23. Taylor ACF, Little AF, Hennessy OF, Banting SW, Smith PJ, Desmond PV (2002) Prospective assessment of magnetic resonance cholangiopancreatography for noninvasive imaging of the biliary tree. Gastrointest Endosc 55:17–22

    Article  PubMed  Google Scholar 

  24. Boraschi P, Neri E, Braccini G et al (1999) Choledocholithiasis: Diagnostic accuracy of MR cholangiopancreatography. Three-year experience. Mag Res Imag 17:1245–1253

    Article  CAS  Google Scholar 

  25. Sugiyama M, Atomi Y, Hachiay J (1998) Magnetic resonance cholangiography using half-fourier acquisition for diagnosing choledocholithiasis. Am J Gastroenterol 93:1886–1890

    Article  PubMed  CAS  Google Scholar 

  26. van Hoe L, Gryspeerdt S, Vanbeckevoort D, De Jaegere T, Ban Steenbergen W, Dewandel P, Baert AL, Marchal G (1998) Normal Vaterian sphincter complex: Evaluation of morphology and contractility with dynamic single-shot MR cholangiopancreatography. AJR Am J Roentgenol 170:1497–1500

    PubMed  Google Scholar 

  27. Fleiss JL (1985) Statistical methods for rates and proportions, 2nd edn. Whiley, New York, pp 211–236

    Google Scholar 

  28. Bret PM, Reinhold C (1997) Magnetic resonance cholangiopancreatography. Endoscopy 29:472–486

    PubMed  CAS  Google Scholar 

  29. Menon K, Barkun AN, Romagnuolo J, Friedman G, Mehta SN, Reinhold C, Bret PM (2001) Patient satisfaction after MRCP and ERCP. Am J Gastroenterol 96:2646–2650

    Article  PubMed  CAS  Google Scholar 

  30. Zidi SH, Prat F, Le Guen O, Rondeau Y, Rocher L, Fritsch J, Choury AD, Pelletier G (1999) Use of magnetic resonance cholangiography in the diagnosis of choledocholithiasis: prospective comparison with a reference imaging method. GUT 44:118–122

    Article  PubMed  CAS  Google Scholar 

  31. Coppens E, Metens T, Winan C, Matos C (2005) Pineapple juice labeled with gadolinium: a convenient oral contrast for magnetic resonance cholangiopancreatography. Eur Radiol 15:2122–2129

    Article  PubMed  Google Scholar 

  32. Staritz M (1988) Pharmacology of the sphincter of Oddi. Endoscopy 20:171–174

    Article  PubMed  Google Scholar 

  33. van Hoe L, Mermuys K, Vanhoenacker P (2004) MRCP pitfalls. Abdom Imaging 29:360–387

    PubMed  Google Scholar 

  34. Régent D (1998) La cholangiopancréatiographie IRM et l’exploration des structures canalaires de demain: tournedos ou carpaccio? J Radiol 79:107–111

    PubMed  Google Scholar 

  35. Dalal PU, Howlett DC, Sallomi DF, Marchbank ND, Watson GMT, Marr A, Dunk AA, Smith AD (2004) Does intravenous glucagon improve common bile duct visualisation during magnetic resonance cholangiopancreatography? Results in 42 patients. Eur J Radiol 49:258–261

    Article  PubMed  Google Scholar 

  36. Okada M, Fukada J, Toya K, Ito R, Ohashi T, Yorozu A (2005) The value of drip infusion cholangiography using multidetector-row helical CT in patients with choledocholithiasis. Eur Radiol 15:2140–2145

    Article  PubMed  Google Scholar 

  37. Eracleous E, Genagritis M, Papanikolaou N, Kontou AM, Prassopoullos P, Chrysikopoulos H, Allan P, Gourtsoyiannis N (2005) Complementary role of helical CT cholangiography to MR cholangiography in the evaluation of biliary function and kinetics. Eur Radiol 15:2130–2139

    Article  PubMed  Google Scholar 

  38. Lo KS, Chen J (1996) The role of ERCP in choledocholithiasis. Abdom Imaging 21:120–132

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, CHUV, Rue du Bugnon, 1011, Lausanne, Switzerland

    S. Schmidt & P. Schnyder

  2. Service d’Imagerie Médicale, Hôpital Archet II, CHU, Nice, France

    P. Chevallier, S. Novellas & J. N. Bruneton

  3. Service de Gastroenterologie, Hôpital Archet II, CHU, Nice, France

    E. Gelsi, G. Vanbiervliet & A. Tran

  4. Service de radiodiagnostic et radiologie interventionnelle, Centre Hospitalier Universitaire Vaudois-CHUV, Rue du Bugnon 1011, Lausanne, Switzerland

    S. Schmidt

Authors
  1. S. Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Chevallier
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Novellas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. Gelsi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Vanbiervliet
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Tran
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. P. Schnyder
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. N. Bruneton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Schmidt.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schmidt, S., Chevallier, P., Novellas, S. et al. Choledocholithiasis: repetitive thick-slab single-shot projection magnetic resonance cholangiopancreaticography versus endoscopic ultrasonography. Eur Radiol 17, 241–250 (2007). https://doi.org/10.1007/s00330-006-0380-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-006-0380-5

Keywords

Search

Navigation