ABSTRACT

Magnetic resonance cholangiopancreatography (MRCP) has emerged as a non-invasive alternative to endoscopic retrograde cholangiopancreatography (ERCP) for diagnosing cholelithiasis. However, the comparative reliability of these methods remains debatable. This study aimed to assess the diagnostic accuracy of MRCP in detecting cholelithiasis in comparison to the gold standard ERCP. We conducted a retrospective review of medical records from three tertiary hospitals between January 2020 and December 2023. Patients who underwent both MRCP and ERCP within a maximum interval of 6 weeks for suspected cholelithiasis were included. ERCP diagnosis was considered the gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRCP for detecting cholelithiasis were calculated. Factors potentially influencing accuracy, such as stone size and location, were analyzed. A total of 72 patients met the inclusion criteria. The overall sensitivity, specificity, PPV, and NPV of MRCP for detecting cholelithiasis were 92.5% (95% CI: 86.3-97.2%), 98.4% (95% CI: 95.7-100%), 97.8% (95% CI: 90.9-99.6%), and 95.2% (95% CI: 90.1-97.9%), respectively. The accuracy was highest for large (>10 mm) stones (97.7%) and lower for small (<5 mm) stones (85.7%). No significant differences in accuracy were observed based on stone location. MRCP demonstrates excellent diagnostic accuracy for cholelithiasis, especially for larger stones, making it a valuable tool for clinical decision-making. While ERCP remains the gold standard, MRCP offers a safe and effective alternative in most cases, promoting a less invasive approach to diagnosing and managing gallstone disease. Future studies with larger, prospective cohorts are needed to further refine the role of MRCP in diagnosing small stones and potentially other biliary pathologies.

Keywords

Cholelithiasis, MRCP, ERCP, Diagnostic accuracy, Sensitivity, Specificity, PPV, NPV.

MJE-012