MAGNETIC RESONANCE CHOLANGIOGRAPHY–AN OVERUSED INVESTIGATION IN PATIENTS WITH SYMPTOMATIC GALLSTONES?

Abstract

Introduction The incidence of choledocholithiasis with symptomatic gallstones has been estimated to be 10-15%. Pre-magnetic resonance cholangiography (MRC), the common bile duct (CBD) was selectively imaged with intra-operative cholangiogram in patients with-(i) deranged liver function (II) a history of jaundice or acute pancreatitis (iii) a dilated CBD. View this table: In this window In a new window Table 1 Aims/Background The aim of this study was to assess the appropriateness of MRC in patients being assessed for choledocholithiasis. Method The medical records of all patients undergoing pre-operative MRC for a 12 month period (Jan 2011-Dec 2011) were identified. Data analysis included: indication for imaging, age, gender, WBC, CRP and liver function tests. Results One hundred and twelve (112) MRC investigations relevant to the study were performed, 35 had positive findings (31%). Regarding patients with choledocholithiasis: Sixteen of 35 had a Bilirubin >30mumol/L. Those with pancreatitis were all >55 years and 3 had severe pancreatitis. Patients with biliary colic all had liver transaminases >twice the upper limit of normal. Analysis of patients with acute cholecystitis found 70%(n=16) were >55 years and 14 had a bilirublin >30mumol/L. Conclusion A selective policy towards imaging the CBD yielded choledocholithiasis in 31% of cases. Pre-operative imaging allows both efficient scheduling of operating lists and ensures a surgeon with the necessary skills to perform laparoscopic bile duct exploration is available in theatre. This is significant as surgical units move toward immediate cholecystectomy for symptomatic gallstones. (Table presented) .