|ECR 2018 / C-0174|
|Combined ultrasound and CT versus MRCP in obstructive jaundice patients|
Ultrasound, CT and MRCP are important diagnostic tools in evaluation of obstructive jaundice patients. Each modlity has its own pros and cons, and each alone may not be suitable or sufficient for all patients to reach diagnosis.
Despite its operator-dependent, machine resolution-dependent, technique-dependent factors, and limitations because of patient habitus (obesity), condition (old age, poor breth-hold) and scanning (bowel gases), ultrasound remains the first imaging modality of choice in obstructive jaundice patients as it is cheaper, safe, fast and readily available, and can be performed as a bed-side or a portable study in ill-patients. Moreover, it doesnot require ionizing radiation.
Computed tomography (CT), though is a useful and informative imaging modality, employs ionizing radiation and uses intravenous contrast administration for better resolution, therefore, is only suitable for certain group of patients. Children, pregnant ladies and those with deteriorated renal function may pose a challenge towards selection of this modality as a diagnostic tool. However, who have contraindications to MRI may benefit from this modality as it requires less time for acquisition.
Magnetic resonance imaging (MRI) does not use ionizing radiation, and provides exquisite tissue details though requires more time for aquisition. Magnetic resonance cholangiopancreatography (MRCP) provides detailed information of biliary ductal system including site/ location and extent of obstruction, besides delineating cause in most of the cases. Breathing and motion artifacts may affect its resolution. Claustrophic patients may require sedation. Patients with metallic implants and pacemaker may not benefit from this modality.
Different studies in literature have evaluated diagnostic capabilities and utilities of these three modlities in different causes of obstructive jaundice patients. Not surprisingly, the diagnostic accuracies are found variable ranging between 20- 80% for ultrasound and CT, and 80- 95% for MRCP [1, 2]. These variations in diagnostic capabilities might be attributed to above-mentioned machine-factors, imaging limitations and resolution, patient's condition and underlying causes [3, 4].
Diagnostic accuracy of combined ultrasound and CT are found nearly comparable to MRCP in our study for the evaluation of obstructive jaundice patients, and combination of these may be used to reach diagnosis in patients having contraindications to MRI or where MRI facility is not available.
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