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MRCP for investigation of mild common bile duct dilatation on ultrasound: are we performing too many?
EP30637
Poster Title: MRCP for investigation of mild common bile duct dilatation on ultrasound: are we performing too many?
Submitted on 07 Nov 2019
Author(s): Dr Sophie Glenn-Cox, Dr Hedvig Karteszi, Dr Huw Roach, Dr Helena Barton
Affiliations: University Hospitals Bristol NHS Foundation Trust
This poster was presented at BIR Annual Congress 2019
Poster Views: 140
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Poster Information
Abstract: Introduction
Biliary dilatation is a common diagnostic problem; the commonest cause of which is a common bile duct (CBD) stone. However, there is a lack of consensus opinion on appropriate investigation of patients with biliary dilatation where a CBD stone is less likely (i.e. normal liver function tests (LFTs) or no gallstones on ultrasound) and MRCP is commonly used.

Objectives
Identify the yield of MRCP in patients with mild CBD dilatation (≤12mm) and correlate these findings with the LFTs.

Methods
The study included 75 consecutive patients who underwent MRCP following ultrasound identification of mildly dilated CBD (≤12mm). MRCP and ultrasound scans were reviewed and data collected on patient demographics and LFTs

Results
LFTs were tested in 74/75 cases. In 25 cases they were normal (34%). The MRCP findings in patients with normal LFTs were benign (most commonly normal, mild proximal CBD dilatation in the absence of gallstones or uncomplicated gallstones only); specifically there were no cases of malignancy or choledocholithiasis. MRCP yielded additional information to the ultrasound in 15 cases (20%) and 10/15 cases, this was choledocholithiasis. All patients with choledocholithiasis on MRCP had abnormal, obstructive LFTs.

Conclusion
Malignancy was not a cause for mildly dilated CBD on ultrasound (≤12mm) in this cohort. In patients with normal LFTs, no significant biliary pathology was seen. All patients with choledocholithiasis on MRCP had abnormal, obstructive LFTs. The decision to undertake MRCP for mild biliary dilatation should be considered in conjunction with the patients’ clinical picture including LFTs.
Summary: We evaluated the imaging findings and characteristics of patients who underwent magnetic resonance cholangiopancreatography (MRCP) for the indication of mild common bile duct (CBD) dilatation of up to 12 mm. References: Holm, A.N. & Gerke, H. What Should Be Done with a Dilated Bile Duct? Curr Gastroenterol Rep (2010) 12: 150. https://doi.org/10.1007/s11894-010-0094-3Report abuse »
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