This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (32)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Surgery, Other  • Alert me on articles by topic

Nicolas Demartines, MD; Lucas Eisner, MD; Karl Schnabel, MD; Ronny Fried, MD; Markus Zuber, MD; Felix Harder, MD

Arch Surg. 2000;135:148-152.

Hypothesis  Magnetic resonance cholangiography (MRC) offers the potential for accurate, noninvasive detection of common bile duct stones (CBDSs) before cholecystectomy, and for a consequent reduction in the incidence of preoperative negative diagnoses associated with endoscopic retrograde cholangiography (ERC).

Design  Prospective cohort study: MRC results were correlated with ERC (high-risk patients) or intraoperative cholangiography (moderate-risk patients).

Setting  A university hospital providing primary, secondary, and tertiary care.

Patients  Seventy patients with suspected CBDSs scheduled to undergo elective cholecystectomy between April 15, 1997, and September 30, 1998. Forty patients were considered at high risk and 30 at moderate risk for CBDSs, according to results of liver function tests and sonograms of the upper abdomen.

Main Outcome Measures  Confirmation or exclusion of CBDSs by MRC was assessed by a panel of radiologists who were unaware of the ERC results. Results of ERC and intraoperative cholangiography were analyzed by the investigating gastroenterologists or surgeon.

Results  Results of MRC were positive for CBDSs in 21 (52%) of 40 high-risk patients, a finding confirmed by preoperative ERC in 19 (90%) of 21 patients. Results of MRC were positive for CBDSs in 6 (20%) of 30 moderate-risk patients, all of which were confirmed by intraoperative cholangiography. Finally, CBDSs were present in 19 (48%) of 40 high-risk patients and 6 (20%) of 30 moderate-risk patients (P = .02). Overall sensitivity and specificity of MRC were 100% and 95.6%, respectively; the positive and negative predictive values were 92.6% and 100%, respectively.

Conclusions  Magnetic resonance cholangiography is a reliable, noninvasive method for the detection or exclusion of CBDSs, and seems to reduce the frequency of negative diagnoses associated with ERC. Magnetic resonance cholangiography revealed no CBDSs in 19 (48%) of 40 patients at high risk for CBDSs. Thus, MRC-based diagnosis has the potential to reduce the number of invasive preoperative diagnostic procedures and their associated risks and overall health care costs.

From the Departments of Surgery (Drs Demartines, Eisner, Zuber, and Harder), Radiology (Dr Schnabel), and Medicine (Dr Fried), University Hospital of Basel, Basel, Switzerland.

RELATED ARTICLE

Archives of Surgery Reader's Choice: Continuing Medical Education
Arch Surg. 2000;135(2):241-242.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Guidelines on the management of common bile duct stones (CBDS)
Williams et al.
Gut 2008;57:1004-1021.
ABSTRACT | FULL TEXT  

Preoperative Evaluation of Common Bile Duct Stones in Patients with Gallstone Disease
Kim et al.
Am. J. Roentgenol. 2005;184:1854-1859.
ABSTRACT | FULL TEXT  

Magnetic Resonance Cholangiopancreatography: A Meta-Analysis of Test Performance in Suspected Biliary Disease
Romagnuolo et al.
ANN INTERN MED 2003;139:547-557.
ABSTRACT | FULL TEXT  

MR Cholangiography in Symptomatic Gallstones: Diagnostic Accuracy according to Clinical Risk Group
Kim et al.
Radiology 2002;224:410-416.
ABSTRACT | FULL TEXT