Role of magnetic resonance cholangiopancreatography in diagnosing choledochal cysts: Case series and review

Table 1 Demographics, physical exam, abdominal ultrasound, computed tomography scan, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography and intraoperative findings for each subject

Patient/age (yr)/sex	Abdominal pain RUQ/epigastric	Ultrasound	CT abdomen	MRCP	Intraoperative/ERCP results
1/16/F	Yes	Intrahepatic biliary dilatation, cystic mass from porta hepatis to pancreatic head	Cyst extending from pancreatichead to anterior hepatic area	Type IV CC Positive APBJ	Type IV CC Positive APBJ
2/6/F	Yes	Saccular dilatation of CBD	Not done	Type IV CC Positive APBJ	Type IV CC Positive APBJ
3/74/F	Yes	Dilated cystic structure in CBD, choledocholithiasis	Dilated cystic structure in CBD, choledocholithiasis	Type IV CC Long common channel, CBD stones	Type IV CC Long common channel, CBD stones
4/47/M	Yes	Dilated CBD	Not done	Type IV CC, positive APBJ, cholelithiasis	Type IV CC, positive APBJ, cholelithiasis
5/30/F	Yes	Not done	Not done	Type IV CC Long common channel	Type IV CC Long common channel
6/69/F	Yes	Dilated CBD	Not done	Type IV CC	Type IV CC
7/58/M	Yes	Dilated CBD, distended gall bladder wall	Dilated CBD, distended gall bladder wall	New variant (dilated CBD and dilated cystic duct), long common channel	New variant (dilated CBD and dilated cystic duct), long common channel
8/49/M	Yes	Not done	Not done	Type I CC, positive APBJ, pancreatic duct stone,cholelithiasis	Type I CC, positive APBJ, pancreatic duct stone, cholelithiasis

F: Female; M: Male; RUQ: Right upper quadrant; CBD: Common bile duct; CT: Computerized tomography; MRCP: Magnetic resonance cholangiopancreatography; ERCP: Endoscopic retrograde cholangiopancreatography; CC: Choledochal cyst; APBJ: Abnormal pancreaticobiliary junction.

Table 2 Contrasts, relative disadvantages, and contraindications for magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography

MRCP	ERCP
Highlight any structure with static fluid	Requires opacification with injected contrast media
Noninvasive so safe esp. in children and pregnant patients	Invasive
Lower cost, faster	20% more expensive than MRCP
No sedation except in few patients	Sedation required
Delineate structures proximal to obstruction.	May fail in patients because of possible tight stricture
No therapeutic intervention	Therapeutic intervention possible
Doesnot use iodine-based com pounds	Requires iodine-based compound usage
Disadvantages
Duct images obscured by other fluid structures	Risk of pancreatitis
(renal cysts, ascites, pseudocyst)	Intraluminal bleeding
Image artifacts from stents, clips, etc.	Duodenal perforation
	Bile leaks
	Stent migration
Contraindications
Claustrophobic patient	Patient with previous biliary or gastric surgery
Patients with ferromagnetic implants	Patients with high risk profile for general anesthesia

MRCP: Magnetic resonance cholangiopancreatography; ERCP: Endoscopic retrograde cholangiopancreatography.

Table 3 Ability of magnetic resonance cholangiopancreatography to determine the presence of choledochal cysts in previous studies

Ref.	Total No. of Pts.	Enrollment	Blinding	Total with CC1	CC detected	Not detected
Hirohashi et al[47]	10	Retrospective	Not stated	5	5	0
Sugiyama et al[22]	11	Prospective	Unblinded	7	7	0
Chan et al[44]	11	Retrospective	Not stated	6	6	0
Irie et al[56]	16	Retrospective	Blinded	16	16	0
Matos et al[57]	8	Prospective	Blinded	8	8	0
Govil et al[58]	9	Retrospective	Not stated	9	9	0
Miyazaki et al[43]	6	Prospective	Blinded	6	6	0
Frampas et al[54]	5	Retrospective	Not stated	5	5	0
Shimuzu et al[59]	16	Prospective	Blinded	7	7	0
Tang et al[77]	10	Prospective	Not stated	10	10	0
Kim et al[60]	20	Retrospective	Blinded	20	20	0
Park et al[55]	72	Retrospective	Blinded	72	69	3
Suzuki et al[61]	33	Retrospective	Blinded	32	32	0
Fitoz et al[62]	23	Retrospective	Blinded	5	5	0
Huang et al[63]	60	Retrospective	Unblinded	22	22	0
Saito et al[64]	16	Retrospective	Blinded	16	16	0
Michaelides et al[65]	6	Retrospective	Not stated	6	6	0
De Angelis et al[66]	28	Retrospective	Not stated	15	15	0
Sacher et al	8	Retrospective	Blinded	8	8	0

¹As determined by intraoperative/endoscopic retrograde cholangiopancreatography findings. CC detected: Choledochal cyst detected by magnetic resonance cholangiopancreatography.

Table 4 Ability of magnetic resonance cholangiopancreatography to determine the presence of an abnormal pancreaticobiliary junction in previous studies and various magnetic resonance cholangiopancreatography sequences stated in the previous studies

Ref.	Patients with CC	True positives	True negatives	False positives	False negatives	MRI sequences
Hirohashi et al[47]	5	4	0	0	1	HASTE
Sugiyama et al[22]	7	5	0	0	2	HASTE
Chan et al[44]	6	0	4	0	2	2D TSE
Irie et al[56]	16	10	1	0	5	HASTE
Matos et al[57]	8	6	2	0	0	SSTSE
Miyazaki et al[43]	6	2	3	0	1	HASTE
Frampas et al[54]	5	1	4	0	0	HASTE
Shimuzu et al[59]	7	6	0	0	1	HASTE
Tang et al[77]	10	6	2	0	2	HASTE
Kim et al[60]	20	12	3	0	5	SSFSE
Park et al[55]	72	34	28	3	7	HASTE
Suzuki et al[61]	32	16	2	0	14	HASTE
Fitoz et al[62]	5	1	4	0	0	SSFSE
Saito et al[64]	16	9	2	0	5	3D SSTSE
Sacher et al	8	7	1	0	0	HASTE

CC: Choledochal cyst; MRI: Magnetic resonance imaging; HASTE: Half-fourier acquisition single-shot turbo spin-echo (Siemens); SSFSE: Single-shot fast spin echo (GE Medical systems); SSTSE: Single-shot turbo spin echo (Philips); 2D TSE: 2 dimensional turbo spin echo; 3D SSTSE: 3 dimensional single shot turbo spin echo.

Table 5 Ability of magnetic resonance cholangiopancreatography to detect choledocholithiasis in previous studies

Ref.	Choledocholithiasisdetected by MRCP	Choledocholithiasisdetected by all means
Hirohashi et al[47]	4	4
Sugiyama et al[22]	1	2
Irie et al[56]	0	2
Matos et al[57]	2	2
Govil et al[58]	3	3
Frampas et al[54]	3	3
Kim et al[60]	8	8
Park et al[55]	8	8
Suzuki et al[61]	10	13
Sacher et al	1	1

MRCP: Magnetic resonance cholangiopancreatography.