Role of magnetic resonance cholangiopancretography (MRCP) on clinical decisions: A diagnostic yield study.

Purpose: to investigate the impact of MRCP as the only imaging procedure in determining the clinical management of patients with suspected biliary or pancreatic disease. Methods and Materials: from October 2004 to July 2006 51 subjects (including 17 liver-transplanted patients) with suspected biliary or pancreatic disease underwent MRCP on a 1.5T system equipped with a surface body coil, using a heavy T2-weighted TSE-3D sequence with the multislice technique. The clinical history of subjects has been retrospectively evaluated to determine the diagnostic accuracy of MRCP and the effects on clinical decision making. Diagnostic confirmation of MRCP findings was obtained with therapeutic direct cholangiography (n=13), surgery and histologic study (n=8), and clinical follow-up (n=30). Results: MRCP detected pathologic findings in 38/51 cases (74,5%) (C.I.95%:[0,60;0,88]), changing the initial clinical diagnosis in a significant proportion of subjects (18/51; 35,3%) (p<0,05). Due to MRCP findings, patients were addressed to medical therapy (n=17) or clinical follow-up (n=13) in 30 cases (58,8%) and to surgery or interventional procedures in 21 cases (41,2%). MRCP showed a sensitivity, specificity, PPV, NPV and overall accuracy of 92,1%, 84,6%, 94,5%, 78,5% and 90,1%, respectively, determining 3 false-negative and 2 false-positive results. A significant proportion (p<0,05) of patients (46/51; 90,2%) (C.I.95%:[0,82;0,98]) appeared to benefit from the execution of the MRCP, including 33/38 cases (86,8%) (C.I.95%:[0,76;0,97]) with pathologic findings. Benefit slightly prevailed in patients with biliary rather than pancreatic disease (91,8% vs 85,7%, respectively). Conclusion: MRCP is a reliable tool in addressing patients with suspected biliary or pancreatic disease to adequate therapeutic procedures.