E1898. The Diagnostic Yield of Magnetic Resonance Cholangiopancreatography in the Setting of Acute Biliary Disease: A Single Center Experience
McMaster University; Saint Joseph's Hospital
Juravinksi Hospital, Hamilton Health Sciences; McMaster University
School of Kinesiology and Health Science, York University
The aim of this study was to evaluate the yield of Magnetic Resonance Cholangiopancreatography (MRCP) studies performed for acute biliary pathology, and to assess reliable predictors of a positive study.
Materials and Methods:
Consecutive patients who underwent an urgent MRCP for acute biliary pathology between January 2017-December 2018 at our institution were retrospectively evaluated. Multivariate binary logistic regression was performed to assess for predictors of an abnormal ‘positive’ MRCP. An additional binary logistic regression model was performed to assess for predictors of significant discrepant imaging results. Patient demographics, biochemistry and an abnormal preceding ultrasound (US) were scrutinized as potential predictive factors.
A total of 155 patients (mean age 56, 44 males, 111 females) were included in the study. It was found that an elevated lipase (OR 5.33, p<0.05) and a positive ultrasound (OR 40.75, p<0.05) were independent predictors for a subsequent positive MRCP. Additionally, older patients were more likely to have a positive MRCP study. In contrast, patient gender and liver function test abnormalities were not predictors of a positive MRCP. In 89 cases (57%) the MRCP findings matched those made on the preceding US. In the remaining 66 cases (43%) with discordant US/MRCP findings, 33 cases (21.3%) had no significant findings that would alter clinical management, such as uncomplicated pancreatitis. However, 33 cases (21.3%) had clinically significant discrepant findings including choledocholithiasis, biliary/pancreatic neoplasia and complicated pancreatitis. The sole predictor for a clinically significant discrepant US/ MRCP was patient age, with 2% increase in the odds of having a significantly discrepant US/MRCP with every year of increase in age.
Elevated lipase and abnormal biliary US serve as predictors of a positive MRCP. These positive MRCPs do not necessarily provide added clinical value even when there are findings discrepant from sonographic assessment. The sole predictor for a clinically significant discrepant MRCP exam from preceding US was increased patient age.