FTP7.3 Retrospective Cohort Study of the Efficacy of Magnetic Resonance Cholangiopancreatography in the Diagnosing Choledocholithiasis in Risk-Stratified Patients
Carla Stevenson, Shou Kee Ng, Brian Stewart, Domenic Di Rollo, Sajid Mahmud, Khurram Khan- Surgery
Abstract
Aims
National guidelines emphasise the role of magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of choledocholithiasis to guide further management. The aim of this study was to determine the risk factor(s) associated with choledocholithiasis on MRCP.
Methods
A retrospective cohort study of all consecutive adult MRCPs was conducted in a single centre from October 2021 to September 2022. Patient demographics, laboratory results, other imaging modalities and MRCP results were analysed. Peak liver function test values were used pre-MRCP. Patients found to have hepatopancreatobiliary malignancies were excluded.
Results
A total of 442 patients were identified, 278 (62.9%) were female. Median age was 63 (IQR 50-74). 293 (66.3%) were inpatient scans whilst 178 (40.3%) were urgent requests. Median time from admission to MRCP performed for inpatients was 2.2 days (IQR 1.4-4.1). 121 (27.4%) MRCPs reported positive for choledocholithiasis.
Choledocholithiasis on MRCP was positively correlated to raised alkaline phosphatase (p=0.004), hyperbilirubinaemia (p<0.001), jaundice (p<0.001) and evidence of ductal dilatation on ultrasound and/or CT imaging (p<0.001). It was not correlated to upper abdominal pain, age and gender.
Conclusion
The incidence of choledocholithiasis on MRCP in this study is comparable to recent published data. Patients should be risk-stratified and MRCP performed only if they have high-risk features to maximise the utility of MRCP.