Skip to main content
SpringerLink
Log in

Diagnostic performance of magnetic resonance cholangiopancreatography (MRCP) versus endoscopic retrograde cholangiopancreatography (ERCP) in the pediatric population: a clinical effectiveness study

  • Hepatobiliary
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To determine the diagnostic performance of magnetic resonance cholangiopancreatography (MRCP) for detecting biliary and pancreatic abnormalities in a pediatric population, using endoscopic retrograde cholangiopancreatography (ERCP) as the reference standard.

Materials and methods

Institutional review board approval with a waiver of informed consent was obtained for this retrospective investigation. Records from the Cincinnati Children’s Hospital Medical Center, Division of Gastroenterology and Department of Radiology were used to identify patients aged ≤ 18 years who had undergone both ERCP and MRCP within a 4-week interval between January 2013 and May 2017. Biliary and pancreatic duct findings were documented for each modality to determine the diagnostic performance of MRCP (with 95% confidence intervals), using ERCP as the reference standard.

Results

54 patients met inclusion criteria. Mean patient age at time of ERCP was 10.4 ± 4.9 years, and 25 (46%) were male. Mean interval between ERCP and MRCP was 11.2 ± 9.7 days. For detection of any abnormality (n = 99 ERCP findings), MRCP had a sensitivity of 76.8% (67.5–84.0%) and a positive predictive value (PPV) of 81.7% (72.7–88.3%). MRCP was 75.7% (59.9–86.6%) sensitive, with a PPV of 84.9% (69.1–93.4%) for biliary findings (n = 37) and 73.5% (59.7–83.8%) sensitive, with a PPV of 78.3% (64.4–87.7%) for pancreatic findings (n = 49). For pancreatobiliary abnormalities (n = 13), MRCP had a sensitivity of 92.3% (66.7–99.6%) and a PPV of 85.7% (60.1–97.5%).

Conclusion

In clinical practice, MRCP is moderately sensitive for biliary and pancreatic abnormalities, with false-negative and false-positive examinations being relatively common.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. McCune WS, Shorb PE, Moscovitz H (1968) Endoscopic cannulation of the ampulla of vater: a preliminary report. Annals of surgery 167:752-756.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Adler DG, Baron TH, Davila RE, et al (2005) ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointestinal endoscopy 62:1-8.

    Article  PubMed  Google Scholar 

  3. Enestvedt BK, Tofani C, Lee DY, et al (2013) Endoscopic retrograde cholangiopancreatography in the pediatric population is safe and efficacious. Journal of pediatric gastroenterology and nutrition 57:649-654.

    Article  PubMed  Google Scholar 

  4. Giefer MJ, Kozarek RA (2015) Technical outcomes and complications of pediatric ERCP. Surgical Endoscopy 29:3543-3550.

    Article  PubMed  Google Scholar 

  5. Guibaud L, Bret PM, Reinhold C, et al (1995) Bile duct obstruction and choledocholithiasis: diagnosis with MR cholangiography. Radiology 197:109-115.

    Article  CAS  PubMed  Google Scholar 

  6. Masci E, Toti G, Mariani A, et al (2001) Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. The American journal of gastroenterology 96:417-423.

    Article  CAS  PubMed  Google Scholar 

  7. Loperfido S, Angelini G, Benedetti G, et al (1998) Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointestinal endoscopy 48:1-10.

    Article  CAS  PubMed  Google Scholar 

  8. Bilbao MK, Dotter CT, Lee TG, et al (1976) Complications of endoscopic retrograde cholangiopancreatography (ERCP). A study of 10,000 cases. Gastroenterology 70:314-320.

    Article  CAS  PubMed  Google Scholar 

  9. Christensen M, Matzen P, Schulze S, et al (2004) Complications of ERCP: a prospective study. Gastrointestinal endoscopy 60:721-731.

    Article  PubMed  Google Scholar 

  10. Freeman ML (2012) Complications of endoscopic retrograde cholangiopancreatography: avoidance and management. Gastrointestinal endoscopy clinics of North America 22:567-586.

    Article  PubMed  Google Scholar 

  11. Ong TZ, Khor JL, Selamat DS, et al (2005) Complications of endoscopic retrograde cholangiography in the post-MRCP era: a tertiary center experience. World journal of gastroenterology 11:5209-5212.

    PubMed  PubMed Central  Google Scholar 

  12. Hekimoglu K, Ustundag Y, Dusak A, et al (2008) MRCP vs. ERCP in the evaluation of biliary pathologies: review of current literature. Journal of digestive diseases 9:162-169.

    Article  PubMed  Google Scholar 

  13. Morimoto K, Shimoi M, Shirakawa T, et al (1992) Biliary obstruction: evaluation with three-dimensional MR cholangiography. Radiology 183:578-580.

    Article  CAS  PubMed  Google Scholar 

  14. Wallner BK, Schumacher KA, Weidenmaier W, et al (1991) Dilated biliary tract: evaluation with MR cholangiography with a T2-weighted contrast-enhanced fast sequence. Radiology 181:805-808.

    Article  CAS  PubMed  Google Scholar 

  15. Bhat M, Romagnuolo J, da Silveira E, et al (2013) Randomised clinical trial: MRCP-first vs. ERCP-first approach in patients with suspected biliary obstruction due to bile duct stones. Alimentary pharmacology & therapeutics 38:1045-1053.

    Article  CAS  Google Scholar 

  16. Kaltenthaler EC, Walters SJ, Chilcott J, et al (2006) MRCP compared to diagnostic ERCP for diagnosis when biliary obstruction is suspected: a systematic review. BMC medical imaging 6:9.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Lee MG, Lee HJ, Kim MH, et al (1997) Extrahepatic biliary diseases: 3D MR cholangiopancreatography compared with endoscopic retrograde cholangiopancreatography. Radiology 202:663-669.

    Article  CAS  PubMed  Google Scholar 

  18. Fulcher AS, Turner MA, Franklin KJ, et al (2000) Primary sclerosing cholangitis: evaluation with MR cholangiography-a case-control study. Radiology 215:71-80.

    Article  CAS  PubMed  Google Scholar 

  19. Choi JY, Lee JM, Lee JY, et al (2008) Navigator-triggered isotropic three-dimensional magnetic resonance cholangiopancreatography in the diagnosis of malignant biliary obstructions: comparison with direct cholangiography. Journal of magnetic resonance imaging : JMRI 27:94-101.

    Article  PubMed  Google Scholar 

  20. Kim TK, Kim BS, Kim JH, et al (2002) Diagnosis of intrahepatic stones: superiority of MR cholangiopancreatography over endoscopic retrograde cholangiopancreatography. AJR American journal of roentgenology 179:429-434.

    Article  PubMed  Google Scholar 

  21. Sica GT, Braver J, Cooney MJ, et al (1999) Comparison of endoscopic retrograde cholangiopancreatography with MR cholangiopancreatography in patients with pancreatitis. Radiology 210:605-610.

    Article  CAS  PubMed  Google Scholar 

  22. Gillams AR, Kurzawinski T, Lees WR (2006) Diagnosis of duct disruption and assessment of pancreatic leak with dynamic secretin-stimulated MR cholangiopancreatography. AJR American journal of roentgenology 186:499-506.

    Article  CAS  PubMed  Google Scholar 

  23. Kim MJ, Han SJ, Yoon CS, et al (2002) Using MR cholangiopancreatography to reveal anomalous pancreaticobiliary ductal union in infants and children with choledochal cysts. AJR American journal of roentgenology 179:209-214.

    Article  PubMed  Google Scholar 

  24. Vitellas KM, El-Dieb A, Vaswani KK, et al (2002) MR cholangiopancreatography in patients with primary sclerosing cholangitis: interobserver variability and comparison with endoscopic retrograde cholangiopancreatography. AJR American journal of roentgenology 179:399-407.

    Article  CAS  PubMed  Google Scholar 

  25. Moon JH, Cho YD, Cha SW, et al (2005) The detection of bile duct stones in suspected biliary pancreatitis: comparison of MRCP, ERCP, and intraductal US. The American journal of gastroenterology 100:1051-1057.

    Article  PubMed  Google Scholar 

  26. Varghese JC, Farrell MA, Courtney G, et al (1999) Role of MR cholangiopancreatography in patients with failed or inadequate ERCP. AJR American journal of roentgenology 173:1527-1533.

    Article  CAS  PubMed  Google Scholar 

  27. Soto JA, Yucel EK, Barish MA, et al (1996) MR cholangiopancreatography after unsuccessful or incomplete ERCP. Radiology 199:91-98.

    Article  CAS  PubMed  Google Scholar 

  28. Kolodziejczyk E, Jurkiewicz E, Pertkiewicz J, et al (2016) MRCP Versus ERCP in the Evaluation of Chronic Pancreatitis in Children: Which Is the Better Choice? Pancreas 45:1115-1119.

    Article  PubMed  Google Scholar 

  29. Irie H, Honda H, Jimi M, et al (1998) Value of MR cholangiopancreatography in evaluating choledochal cysts. AJR American journal of roentgenology 171:1381-1385.

    Article  CAS  PubMed  Google Scholar 

  30. Singal AG, Higgins PDR, Waljee AK (2014) A Primer on Effectiveness and Efficacy Trials. Clinical and Translational Gastroenterology 5:e45-.

  31. Adamek HE, Albert J, Breer H, et al Pancreatic cancer detection with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography: a prospective controlled study. The Lancet 356:190-193.

  32. Angulo P, Pearce DH, Johnson CD, et al (2000) Magnetic resonance cholangiography in patients with biliary disease: its role in primary sclerosing cholangitis. Journal of hepatology 33:520-527.

    Article  CAS  PubMed  Google Scholar 

  33. Reinhold C, Taourel P, Bret PM, et al (1998) Choledocholithiasis: evaluation of MR cholangiography for diagnosis. Radiology 209:435-442.

    Article  CAS  PubMed  Google Scholar 

  34. Shanbhogue AK, Tirumani SH, Prasad SR, et al (2011) Benign biliary strictures: a current comprehensive clinical and imaging review. AJR American journal of roentgenology 197:W295-306.

    Article  PubMed  Google Scholar 

  35. Arcement CM, Meza MP, Arumanla S, et al (2001) MRCP in the evaluation of pancreaticobiliary disease in children. Pediatric radiology 31:92-97.

    Article  CAS  PubMed  Google Scholar 

  36. Delaney L, Applegate KE, Karmazyn B, et al (2008) MR cholangiopancreatography in children: feasibility, safety, and initial experience. Pediatric radiology 38:64-75.

    Article  PubMed  Google Scholar 

  37. Tipnis NA, Dua KS, Werlin SL (2008) A retrospective assessment of magnetic resonance cholangiopancreatography in children. Journal of pediatric gastroenterology and nutrition 46:59-64.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA

    Jonathan R. Dillman, Alexander J. Towbin & Andrew T. Trout

  2. Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Jonathan R. Dillman, Rakesh M. Patel, Alexander J. Towbin & Andrew T. Trout

  3. Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Tom K. Lin

Authors
  1. Jonathan R. Dillman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rakesh M. Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tom K. Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alexander J. Towbin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrew T. Trout
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jonathan R. Dillman.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dillman, J.R., Patel, R.M., Lin, T.K. et al. Diagnostic performance of magnetic resonance cholangiopancreatography (MRCP) versus endoscopic retrograde cholangiopancreatography (ERCP) in the pediatric population: a clinical effectiveness study. Abdom Radiol 44, 2377–2383 (2019). https://doi.org/10.1007/s00261-019-01975-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-019-01975-8

Keywords

Search

Navigation