Diagnostic accuracy of magnetic resonance cholangiopancreatography to detect benign and malignant biliary strictures

Shabanikia, Niloufar; Adibi, Atoosa; Ebrahimian, Shadi

Diagnostic accuracy of magnetic resonance cholangiopancreatography to detect benign and malignant biliary strictures

Document Type : Original Article

Authors

Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive method to detect pancreaticobiliary strictures. In this study, we aimed to evaluate the diagnostic performance of MRCP and detect sensitive and specific radiologic features in distinguishing malignant and benign pathologies. Materials and Methods: In this study, 50 patients with biliary obstruction and a confirmed diagnosis using histopathology were included. The pathologies were evaluated using MRCP which were categorized into malignant and benign strictures. The etiology of strictures was detected using histopathology and endoscopic retrograde cholangiopancreatography. The diagnostic performance of MRCP was calculated using SPSS software. P < 0.05 was considered statistically significant. Results: Of 50 patients, 23 patients (46%) had malignant strictures based on MRCP and histopathology. The sensitivity and specificity of MRCP to detect malignancy were 95.7% and 96.3%, respectively. The most sensitive MRCP features to detect malignancy were upstream biliary duct dilation, abrupt tapering, and the presence of a solid mass with sensitivity 100%, 95.7%, and 78.2%, respectively. The malignancy rate was significantly higher in the strictures with length >11.5 mm or wall thickness >2.75 mm (P < 0.05). Conclusion: MRCP is a sensitive method to differentiate malignant lesions from benign pathologies. A long and thick stricture with the presence of a solid mass, upstream biliary duct dilation, and abrupt tapering is highly suggestive of malignancy.

Keywords

References

1.	Fernandez Y, Viesca M, Arvanitakis M. Early diagnosis and management of malignant distal biliary obstruction: A review on current recommendations and guidelines. Clin Exp Gastroenterol 2019;12:415-32.
2.	Rezvani M, Menias C, Sandrasegaran K, Olpin JD, Elsayes KM, Shaaban AM. Heterotopic pancreas: Histopathologic features, imaging findings, and complications. Radiographics 2017;37:484-99.
3.	Oh I, Bates W, Estes T, Roda M, Moreno C, Mittal P. Benign and malignant biliary strictures: Diagnostic features from MRI and both diagnostic and therapeutic role of percutaneous intervention. Eur Congr Radiol 2019
4.	Griffin N, Charles-Edwards G, Grant LA. Magnetic resonance cholangiopancreatography: The ABC of MRCP. Insights Imaging 2012;3:11-21.
5.	Wang Y, Wang Y, Yang T, Chen Y. Value of Magnetic Resonance Cholangiopancreatography Combined with Dynamic Contrast Enhanced CT in Differential Diagnosis of Benign and Malignant Biliary Stricture; 2017;28;16.
6.	Rajab L. Correlation of MRCP and Surgical Findings in Patients with Obsructive Jaundice at MNH: Muhimbili University of Health and Allied Sciences; 2017.
7.	Suthar M, Purohit S, Bhargav V, Goyal P. Role of MRCP in differentiation of benign and malignant causes of biliary obstruction. J Clin Diagn Res 2015;9:TC08-12.
8.	Dillman JR, Patel RM, Lin TK, Towbin AJ, Trout AT. Diagnostic performance of magnetic resonance cholangiopancreatography (MRCP) versus endoscopic retrograde cholangiopancreatography (ERCP) in the pediatric population: A clinical effectiveness study. Abdom Radiol (NY) 2019;44:2377-83.
9.	Saxena S, Prajapati D, Doctor M, Patel H. Role of 3T magnetic resonance cholangiopancreatography (MRCP) in biliary strictures in adult population of western India. Int J Sci Res 2019;8:63-66.
10.	Abdelrahman AS, Muhammed ZM. Role of magnetic resonance cholangio-pancreaticography in differentiating between benign and malignant causes of biliary obstruction. Egypt J Hosp Med 2017;68:954-66.
11.	Katabathina VS, Dasyam AK, Dasyam N, Hosseinzadeh K. Adult bile duct strictures: Role of MR imaging and MR cholangiopancreatography in characterization. Radiographics 2014;34:565-86.
12.	Lee WJ, Lim HK, Jang KM, Kim SH, Lee SJ, Lim JH, et al. Radiologic spectrum of cholangiocarcinoma: Emphasis on unusual manifestations and differential diagnoses. Radiographics 2001;21:S97-116.
13.	Joo I, Lee JM, Yoon JH. Imaging diagnosis of intrahepatic and perihilar cholangiocarcinoma: Recent advances and challenges. Radiology 2018;288:7-13.
14.	Yu XR, Huang WY, Zhang BY, Li HQ, Geng DY. Differentiation of infiltrative cholangiocarcinoma from benign common bile duct stricture using three-dimensional dynamic contrast-enhanced MRI with MRCP. Clin Radiol 2014;69:567-73.
15.	Kim JY, Lee JM, Han JK, Kim SH, Lee JY, Choi JY, et al. Contrast-enhanced MRI combined with MR cholangiopancreatography for the evaluation of patients with biliary strictures: Differentiation of malignant from benign bile duct strictures. J Magn Reson Imaging 2007;26:304-12.
16.	Boninsegna E, Manfredi R, Negrelli R, Avesani G, Mehrabi S, Pozzi Mucelli R. Pancreatic duct stenosis: Differential diagnosis between malignant and benign conditions at secretin-enhanced MRCP. Clin Imaging 2017;41:137-43.
17.	Kawada N, Uehara H, Nagata S, Tsuchishima M, Tsutsumi M, Tomita Y. Mural nodule of 10 mm or larger as predictor of malignancy for intraductal papillary mucinous neoplasm of the pancreas: Pathological and radiological evaluations. Pancreatology 2016;16:441-8.
18.	Uribarri-Gonzalez L, Keane MG, Pereira SP, Iglesias-García J, Dominguez-Muñoz JE, Lariño-Noia J. Agreement among magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI-MRCP) and endoscopic ultrasound (EUS) in the evaluation of morphological features of Branch Duct Intraductal Papillary Mucinous Neoplasm (BD-IPMN). Pancreatology 2018;18:170-5.
19.	Yagi Y, Masuda A, Zen Y, Shiomi H, Toyama H, Sofue K, et al. Pancreatic inflammation and atrophy are not associated with pancreatic cancer concomitant with intraductal papillary mucinous neoplasm. Pancreatology 2018;18:54-60.

Advanced Biomedical Research