Zeitschriftenartikel zum Thema „Cholangio-MRI“

Agenesis of dorsal pancreas (ADP) is an extremely rare entity. We report a case of 50 year old lady with complete agenesis of the dorsal pancreas presenting with extra-hepatic portal vein obstruction (EHPVO) with symptomatic gall stone disease. Contrast enhanced computed tomography (CECT) revealed a normal pancreatic head, but pancreatic body and tail were not visualized, pancreatic head was compressing upon the portal vein with marked luminal narrowing and cavernoma formation. Magnetic resonance imaging (MRI) and magnetic resonance cholangio pancreatography (MRCP) findings confirmed the CT findings of ADP.

Background The diagnosis of obstructive jaundice relies on proper history taking, clinical examination, laboratory investigations and different non invasive imaging modalities like Ultrasonography (USG), Cholangio Computed Tomography (CCT), Magnetic resonance Imaging (MRI) with Magnetic Resonance Cholangio Pancreatography (MRCP) and invasive modalities like endoscopic retrograde cholangiography (ERCP) and percutaneous trans hepatic cholangiography (PTC). Objective To compare the role of ultrasound with endoscopic retrograde cholangiography and to determine the major causes of obstructive jaundice in our prospect. Methods This was a prospective, analytical study conducted on 88 patients presenting to Department of Radiodiagnosis and Imaging at Dhulikhel Hospital-Kathmandu University hospital from March 2011 to August 2012 with clinical diagnosis of obstructive jaundice. Sonographic evaluation was performed in Siemens acusion x-150 and x-300. The final diagnosis was made by endoscopic retrograde cholangiography and /or surgery and confirmed histopathologically. Results The most common benign causes of obstructive jaundice were choledocholithiasis (63%), CBD stricture (12.3%), cholangitis (8%) and pancreatitis (6.85%) whereas cholangio carcinoma (6.85%) and carcinoma head of pancreas (4%) comprised of the malignant causes . Ultrasonography had sensitivity of 100% and specificity of 89% in detecting choledocholithiasis. It was found to be 98.78% sensitive and 83.33% specific in cholangiocarcinoma. Similarly in pancreatitis, the sensitivity of ultrasonography was 97.59% and sensitivity was 66.67%. Conclusion Ultrasonography acts as a valuable diagnostic imaging modality in detecting the causes of obstructive jaundice. Due to its easy availability, non invasive nature and cost effectiveness, it can be considered as the first line imaging technique/ tool. ERCP is the invasive imaging tool and can be used for both diagnostic and therapeutic purpose. DOI: http://dx.doi.org/10.3126/kumj.v11i3.12512 Kathmandu Univ Med J 2013; 43(3):237-240

Gallbladder agenesis is a rare, little-recognized congenital anomaly, presenting in the form of hepatic colic in 23% of patients. The ultrasound assessment often describes a scleroatrophic vesicle, which can lead to unnecessary and potentially dangerous surgery. We report the case of a 64-year-old man, with no history of cholecystitis, presenting with hepatic colic and whose ultrasound diagnosis of scleroatrophic vesicle was questioned. patient was operated on by the traditional route for gallbladder lithiasis. The absence of a gallbladder was discovered intraoperatively. In order to confirm the diagnosis postoperatively, we performed magnetic resonance imaging (cholangio-MRI) which made the diagnosis of agenesis of the gallbladder.

The agenesis of the gallbladder is a rare, unsung congenital anomaly, presenting itself in different clinical forms. The ultrasound balance sheet often describes a lichen-atrophic vesicle, which can lead to unnecessary and potentially dangerous surgery. We report the case of a 45-year-old patient with no history of Cholecystitis, with cholestasis jaundice and whose ultrasound diagnosis of lichen-atrophic vesicle was questioned. Magnetic resonance imaging (Cholangio-MRI) has led to the diagnosis of gallbladder agenesis. No hepatic or pancreatic abnormalities, the GB couldn’t be found in its normal site, or in an ectopic place. Endoscopic retrogradeCholangio-Pancreatography with sphincterotomy was done to extract the GB stones and to confirm the diagnosis GB agenesis. The evolution has been marked by the improvement of jaundice and the stabilization of laboratory findings.

Abstract Background and study aims The etiology of idiopathic acute pancreatitis (IAP) should always be defined. Our aim was to compare the diagnostic value of endoscopic ultrasound (EUS) versus secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) in patients with IAP. Patients and Methods Patients admitted to a single tertiary care University hospital with IAP were invited to participate in the study. Enrolled patients underwent EUS and S-MRCP in a single-blinded comparative study. EUS and S-MRCP were performed no sooner than 4 weeks after discharge. The diagnostic yield of EUS and S-MRCP and demographic variables were included in the analysis. Additional follow-up, results of subsequent serology, radiographic exams, and relevant histological analysis were considered in determination of the final diagnosis. Results A total of 34 patients were enrolled; EUS was normal in six, cholelithiasis was defined in 15, choledocholithiasis in two, pancreas divisum in three, branch-type intraductal papillary mucinous tumor (IPMT) in three, and chronic pancreatitis in five. S-MRCP identified choledocholithiasis in one, divisum in four, branch-type IPMT in three, chronic pancreatitis in two; 24 subjects diagnosed as normal by S-MRCP. Diagnostic correlation between EUS and S-MRCP was slight (kappa = 0.236, 95 % confidence interval: 0.055–0.416). EUS provided a statistically significantly higher diagnostic yield than S-MRCP: 79.4 % (CI95 %: 65 %–94 %) vs 29.4 % (CI95 %: 13 %–46 %) (P = 0.0002). The sensitivity, specificity, and positive and negative predictive values of EUS and S-MRCP were 90 %, 80 %, 96 %, 57 % and 33 %, 100 %, 100 % and 16 %, respectively. Conclusion The diagnostic yield of EUS is higher than S-MRCP in patients with IAP.

Liver diseases are a common medical problem, especially amongst the population of developing countries. Magnetic Resonance Cholangio Pancreatography (MRCP) has become the popular non-invasive, non-ionizing examination for analysis of the hepatobiliary structure in the liver. Unfortunately, conventional 2D MRCP images can be difficult to analyze for biliary tree anomalies, especially with volume effect, artefacts and noise present in these images, whilst good 3D MRI systems are costly for less affluent nations. This paper proposes a scale-space multi-resolution approach to a segment-based implementation of the popular region growing algorithm, to identify the hierarchical structure of the biliary tree in conventional 2D MRCP images. Results obtained are promising in aiding automatic processing of these images to assist medical practitioners in analyzing the biliary tract more efficiently. Application of the algorithm may be extended for telemedicine.

BACKGROUND: Common bile duct lithiasis is a pathology with a high rate of migration of small stones to the duodenum. However, asymptomatic migration of stones larger than 1cm (macrolithiasis) is atypical. We present a case of migration of a macrocalculus located in the middle of the common bile duct. CASE REPORTS: We present the case of a 27-years-old man, who consulted for postprandial epigastric pain, that started 4 months ago. Abdominal ultrasound showed biliary sludge and common bile duct macrocalculus, with Cholangio-MRI the diagnosis was confirmed. A laparoscopic cholecystectomy with intraoperative cholangiography was performed. EVOLUTION: During the laparoscopic cholecystectomy, no stones were evidenced in the intraoperative cholangiograpy. Due to the disagreement between the preoperative IOC images, transcystic instrumentation with a Dormia basket was performed, without stone extraction. The patient had a favorably evolution, without complications due to the stone migration. Postoperative MRC was performed, without evidence of endoluminal images in the bile duct. CONCLUSIONS: Biliary pathology is dynamic, with the possibility of gallstone migration, even for large gallstones and complicated cases. Although ultrasound and MRI have high sensitivy for diagnosis; IOC is essential to diagnose and treat lithiasic pathology, resolving it in a single operating time, avoiding multiple procedures.

The purpose of this study was to determine the possibility of ARFI- elastography for diagnosis of tumors of the liver. The study included 95 patients with liver tumors. 22 patients were excluded from the study because of the deep location of the formation or the inability to measure the speed performance. Therefore the tumors in 73 patients were obtained by ARFI-elastography and analyzed. Verification of the diagnosis was achieved by histological examination of the material in 93% of cases and by MRI, CT in 7% of cases. Patients were divided by diagnosis: 4 – with benign tumors, 33 – with hepatocellular carcinoma, 4 – with cholangio-carcinoma, 19 – with metastatic colorectal cancer, 13 – with metastases of other cancer. Benign tumors included two focal nodular hyperplasia and hepatocellular adenoma, one cavernous hemangioma a large size. The obtained results were compared with normal liver parenchyma in 77 people. Average speed was: 2.83 m/s in the benign, 1.55 m/s in the normal liver parenchyma, 2.5 m/s at the nodes of hepatocellular carcinoma, 2.66 m/s at the nodes cholangio-carcinomar, 2.79 m/s in the metastasis of colorectal cancer, 2.79 m/s in the remaining metastases. Associated threshold value for the diagnosis of the majority of malignant tumors, it is necessary to consider the speed of over 2 m/s. Sensitivity groups ranged from 59% to 100% and a specificity of 70% to 86%. The results indicate higher speed performance parameters (mean, median, threshold values > 2.3 m/s) in benign tumors. This is due to a small group, as well as the large size of entities – from 5.0 to 24.0 cm, indicating that the long-term course of the disease with the development of fibrosis in them, so the stiffness of education becomes higher. These data prove that the quantitative elastography shear wave can be used as an additional diagnostic tool in oncology, but further accumulation of scientific data, since the values of the groups overlap.

Three distinct entities among non-inflammatory cystic lesions of the pancreas have been defined: intraductal papillary mucinous neoplasm (IPMN), serous cystic neoplasm (SCN) and mucinous cystic neoplasm (MCN). IPMN is characterized by intraductal papillary growth and thick mucus secretion: its incidence has dramatically increased since its initial description. These lesions probably can progress towards invasive carcinoma. IPMNs are symptomatic in most cases: the typical presentation is a recurrent acute pancreatitis, without evident cause, of low or moderate severity. The diagnosis is usually based upon the imaging (CT/cholangio-MRI) demonstrating a pancreatic cystic mass, involving a dilated main duct, eventually associated to some filling defects, or a normal Wirsung duct communicating with the cyst lesion. Surgical treatment is generally indicated for main duct IPMN and branch duct IPMN with suspected malignancy (tumour size ≥ 30 mm, mural nodules, dilated main pancreatic duct, or positive cytology) or prominent symptoms. Herein we present a case of IPMN of the main duct which occurred with abdominal and back pain associated with weight loss. After the diagnosis, she successfully underwent surgery and is now in a follow-up program.

Introduction. In a previously published article the authors reported the long-term follow-up results in 138 consecutive patients with gallstones and common bile duct (CBD) stones who underwent laparoscopic transverse choledochotomy (TC) with T-tube biliary drainage and laparoscopic cholecystectomy (LC). Aim of this study is to evaluate the results at up to 23 years of follow-up in the same series.Methods. One hundred twenty-one patients are the object of the present study. Patients were evaluated by clinical visit, blood assay, and abdominal ultrasound. Symptomatic patients underwent cholangio-MRI, followed by endoscopic retrograde cholangiopancreatography (ERCP) as required.Results. Out of 121 patients, 61 elderly patients died from unrelated causes. Fourteen patients were lost to follow-up. In the 46 remaining patients, ductal stone recurrence occurred in one case (2,1%) successfully managed by ERCP with endoscopic sphincterotomy. At a mean follow-up of 17.1 years no other patients showed signs of bile stasis and no patient showed any imaging evidence of CBD stricture at the site of choledochotomy.Conclusions. Laparoscopic transverse choledochotomy with routine T-tube biliary drainage during LC has proven to be safe and effective at up to 23 years of follow-up, with no evidence of CBD stricture when the procedure is performed with a correct technique.

BACKGROUND Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive imaging method of demonstration of hepatic, cholangio- and pancreatic-systems and their duct system and depends on heavy T2-weighted (T2-W) images. The present study was undertaken to study and evaluate patients with clinical suspicion of the biliary tract, gall bladder and pancreatic pathology, with conventional magnetic resonance imaging (MRI) and MRCP and to assess the pitfalls in MRCP for the evaluation of the biliary tract, gall bladder, and pancreas. METHODS The study included sixty patients with clinical signs and symptoms of obstructive jaundice referred for MRCP to the Department of Radiodiagnosis at Katuri Medical College and Hospital and patients who were referred to the department with clinical suspicion of pancreas, gallbladder and biliary tract disease. Pregnant patients, claustrophobic patients and patients with MRI contraindications such as cardiac pacemakers, aneurysm clips and metallic implants were excluded from the study. RESULTS Most of the patients in our study were of 30 - 70 years age group. Of the sixty cases included in our study, 58 % were males and 42 % were females. In most of the patients, in our study, benign pathology was observed which included cholelithiasis and choledocholithiasis and acute pancreatitis being next common. Case of choledochal cyst were also encountered. Most of common bile duct strictures were of benign aetiology. Of the malignant pathology detected, cholangiocarcinoma followed by periampullary carcinoma and gallbladder carcinoma were commonly encountered. CONCLUSIONS Magnetic resonance pancreatic cholangiography is an imaging modality for evaluation of pancreaticobiliary disorders. MRCP detected the exact location and cause of biliary tract obstruction and aetiology was well demonstrated. Pure cholesterol stones are difficult to detect on CT because they are iso attenuating or slightly hypoattenuating to bile. Sub centimetric calculi are well demonstrated by MRCP. Malignant strictures and benign strictures are well demonstrated. MRCP being non-invasive and radiation hazard free with inherent high resolution with multiplanar imaging capability could be considered as gold standard in imaging of few gall bladder and biliary system disorders. KEYWORDS Magnetic Resonance Cholangiopancreatography, Cholelithiasis, Pancreatitis, Periampullary Carcinoma, Gall Bladder Carcinoma, Cholangiocarcinoma

Abstract Background Patients with Inflammatory Bowel Disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), are at risk of developing malignancies, so prevention and adherence to cancer screening may improve its detection. The aim of this study was to asses the compliance with medical recommendations, especially primary and secondary prevention of cancer. Methods This prospective, one-center study was carried out between June and October 2021r. amongst patients from Department of Internal Medicine and Gastroenterology with IBD Division, Central Clinical Hospital of Ministry of Interior Affairs and Administrations, Warsaw, Poland. Patients were asked to complete anonymous questionnaire which included 42 questions concerning lifestyle, cancer risk factors, cancer history, and checkups in patients with IBD. Results A total of 190 patients with IBD were included in survey. 117 (61.6%) had CD, 67 (35.3%) UC and 6 (3.2%) unclassified disease. 43.7% were women and more than a half of them had >8 years of the length of the disease. In total 84.2% were taking mesalazine, 48.4% immunosupresive medication and 77.9% biological treatment. Statistically significantly (p=0.034) more patients with CD than those with UC practiced regular physical activity (respectively 65.8% and 48.5%). Patients with UC more often were non-smokers (76.7% vs 92.5% for CD and UC respectively; p=0.007). 39.7% of patients with CD and 27.3% with UC declared alcohol consumption (p=0.128). Only 6% of patients responded not to use sun protection measures when sun-bathing but 24.8% with CD and 34.4% with UC didn’t have regular full-body skin examinations. 78.7% of patients had abdominal ultrasound scan performed in the last year. Out of 52.7% who had colonoscopy recommended, 49.3% of patients declared that the examination was carried out (36.8% of CD and 65.5% of UC; p= 0.038) and another endoscopy was scheduled (18.6% of CD and 48.4% of UC; p<0.001). According to respondents cholangio-MRI was recommended to 14.3% patients with CD and 6.2% with UC (p=0.219). Only 1 patient in both groups did not perform this examination. Most of the examinations were recommended by gastroenterologists. Moreover, in the last 12 months 59.6% of female answerer declared to have ultrasound imagining of the breast and 98.7% gynecological examination performed (65.4% had regular Pap-test screening). 82.3% of respondents knew about HPV vaccination but only 25% were vaccinated. Conclusion Our study reveals that many of IBD patients are exposed on risk factors of malignancies. Screening for cancer and regular checkups should be regularly performed. Primary prevention, such as HPV vaccinations, should be reminded to all patients.

Objective: To determine the clinical presentation and different treatment modalities of obstructed jaundice at tertiary care Hospital. Study Design: Prospective observational study. Place and Duration: Present study was conducted in the Department of general Surgery of Liaquat University of Medical and Health Sciences, Jamshoro during two years from July 2015 to June 2017. Patients and Methods: Total 50 patients having obstructed jaundice and either gender were evaluated after taking history, clinical examinations including specific investigations like ultrasound of abdomen, liver function test (LFT), magnetic resonance cholangiopancreatography (MRCP), computed tomography (CT) endoscopic retrograde cholangio pancreatography (ERCP), magnetic resonance imaging (MRI), percutaneous transhepatic cholangiography (PTC) biopsy, tumor markers and x- ray chest for diagnosis and prognosis purpose. All the data was recorded via self-made proforma. Results: Out of all cases, 20 patients were in age group of 30 to 45 year, 21 patients were in age group 46 to 64 years and 09 patients were in age group 65 to 80 year. Thirty one patients were presented with intermittent jaundice and pain,14 patients had jaundice, pruritus, pale stool, dark urine and 5 patients were presented with jaundice, pruritus, pale stool with dark urine, pain, anorexia and weight loss. Thirty one patients were diagnosed with benign lesions and 19 patients had malignant lesions. Most of the patients (26.52%) were treated by ERCP, stent. Fifteen underwent open surgery, and 9 were treated by palliative procedure, chemotherapy, radiotherapy and gene therapy. Conclusion: Obstructed jaundice is a critical problem all over the world, in which initially patients present with jaundice, pain, pruritus with pale stool, dark urine and weight loss. Patients can be treated by ERCP, stent. Fifteen patients underwent open surgery and 9 were treated by palliative procedure, chemotherapy, radiotherapy and gene therapy.

Abstract Background Recently, we reported the feasibility of indocyanine green (ICG) near-infrared fluorescence (NIRF) imaging to identify extrahepatic biliary anatomy during laparoscopic cholecystectomy (LC) in pediatric patients. This paper aimed to describe the use of a new technology, RUBINA™, to perform intra-operative ICG fluorescent cholangiography (FC) in pediatric LC. Methods During the last year, ICG-FC was performed during LC using the new technology RUBINA™ in two pediatric surgery units. The ICG dosage was 0.35 mg/Kg and the median timing of administration was 15.6 h prior to surgery. Patient baseline, intra-operative details, rate of biliary anatomy identification, utilization ease, and surgical outcomes were assessed. Results Thirteen patients (11 girls), with median age at surgery of 12.9 years, underwent LC using the new RUBINA™ technology. Six patients (46.1%) had associated comorbidities and five (38.5%) were practicing drug therapy. Pre-operative workup included ultrasound (n = 13) and cholangio-MRI (n = 5), excluding biliary and/or vascular anatomical anomalies. One patient needed conversion to open surgery and was excluded from the study. The median operative time was 96.9 min (range 55–180). Technical failure of intra-operative ICG-NIRF visualization occurred in 2/12 patients (16.7%). In the other cases, ICG-NIRF allowed to identify biliary/vascular anatomic anomalies in 4/12 (33.3%), including Moynihan's hump of the right hepatic artery (n = 1), supravescicular bile duct (n = 1), and short cystic duct (n = 2). No allergic or adverse reactions to ICG, post-operative complications, or reoperations were reported. Conclusion Our preliminary experience suggested that the new RUBINA™ technology was very effective to perform ICG-FC during LC in pediatric patients. The advantages of this technology include the possibility to overlay the ICG-NIRF data onto the standard white light image and provide surgeons a constant fluorescence imaging of the target anatomy to assess position of critical biliary structures or presence of anatomical anomalies and safely perform the operation.

INTRODUCTION: Biliary & pancreatic pathologies are a wide spectrum of disorders ranging from gall stones to pancreatic carcinoma. Cholangiocarcinoma (CC) is the second commonest primary liver tumour worldwide, after hepatocellular carcinoma (HCC). In suspected biliary obstruction, ultrasonography (US) is reliable for excluding gallstones but is operator-dependent and is insufcient alone for investigating suspected CC. ERCP is needed for assessing the extent of bile duct involvement and respectability. MRCP is better alternative for ERCP as it is non-invasive. Magnetic resonance cholangiopancreatography (MRCP) is an abdominal magnetic resonance (MR) imaging method that allows non-invasive visualization of the pancreato biliary tree and requires no contrast administration. By using heavily T2 weighted sequences, the signal of static or slow-moving uid-lled structures such as the bile and pancreatic ducts is greatly increased, resulting in increased duct-to background contrast. Recent studies have shown that MRCP is comparable with invasive retrograde cholangiopancreatography (ERCP) for diagnosis of extrahepatic bile duct and pancreatic duct abnormalities such as choledocholithiasis, malignant obstruction of the bile and pancreatic ducts, congenital anomalies, and chronic pancreatitis. The use of MRCP in diagnosing biliary obstruction may avoid the use of unnecessary invasive 1 procedures such as ERCP. MRCPhas some advantages over ERCPare non-invasive, cheaper, uses no ionizing radiation, requires no anaesthesia, less operator dependent, better demonstrating ducts proximal to an obstruction or tight stenosis and when combined with conventional T1- and T2- 2-5 weighted sequences, allows anatomic imaging of extra ductal diseases.3 Its diagnostic accuracy has been demonstrated in various studies. AIM/PURPOSE: To estimate the sensitivity, specificity, PPV, NPV in the diagnosis of cholangio-pancreatic diseases by MRCP in comparison to ERCPas gold standard. MATERIALS AND METHODS This was a prospective comparative study conducted in the departments of Radio-diagnosis and Gastroenterology, Apollo hospital, Jubilee hills for a period of 13 months, May 2018- May 2019. Patients with suspected biliary or/and pancreatic pathology referred for MRCP with subsequent assessment by ERCPtaken included in the study. Patients of both genders, all age groups and with suspected cholangiopancreatic disease based on Clinical, Biochemical and USG criteria. In our present study, based on MRCP and ERCP the study population will be classied into 3 groups. Group I (stone disease), group II (stricture), group III (pancreatico biliary tumour).All patients referred to department of radiology Apollo hospital, jubilee hills, Hyderabad was screened and those patients meeting inclusion criteria was informed for the study, an informed consent was obtained and study proforma was completed. MRCP was done using PHILIPS Achieva 1.5 Tesla MRI Machine. MRCP Protocol and MRCP Sequences followed as per standards. All study data from the study proforma sheets was entered into master chart. The sensitivity, specificity, PPV and NPV of each group and their association with benign or malignant was determined by MRCP and compared with that of ERCP finding as gold standard. Data analysis was done using SPSS 23.0 version. RESULTS Out of 76, maximum patients 32 (42.1%) belongs to 41-60 years, 48 (63.2%) were male and 28 (36.8%) were female. Abdominal pain was the most common clinical presentation contributing to 46.1% (35 patients), followed by obstructive jaundice 27 (35.5%), 8 (10.5%) patients were asymptomatic and 6 (7.9%) was on postop follow up. CBD dilatation was seen in 55 patients (72.4%), IHBR dilatation in 40 (52.6%) and 38 (50%) had both. MPD dilatation was present in 16 patients (21%) and both CBD and MPD dilation was seen in 15 (19.7%). MPD dilatation was seen in 16 (21%) of cases and not dilated in 60(89%). The mean CBD diameter in the present study was 9.02 with S.D 3.61and CBD calculus was 8.48 with S.D 3.82 mm. The mean MPD diameter of 76 patients were 3.51 ± 2.18 mm. the MPD diameter ranges from 1.5 to 18 mm. Group 1 (lithiasis): CBD calculus was present in 23 patients (30.3%), 18 (78.3%) were located at distal end, 2 (8.7%) each at proximal and midlevel and 1(4.3%) at the ampulla, GB calculus in 33 patients (43.4%) and both in 12 (15.8%) cases. Among 39 patients ERCP positive for stone, MRCP can accurately detect stones in 86.4% cases and can't able to detect in 13.6% cases. MRCP fails to diagnose one ERCP positive case. There was signicant association found between MRCP and ERCP in detection of stones with p-value < 0.05. Sensitivity, specicity, PPV, NPV and accuracy of MRCP in diagnosing GB and CBD stones when compared to ERCP were 97.4%, 83.8%, 86.4%, 96.8% and 90.8% respectively. Group 2 (strictures): The mean age of patients with stricture was 55.3 ± 16.5 years with age range of 17 -97 yrs. 54.2% of males and 35.7% of female patients had strictures. Among 36 patients ERCP positive for stricture, MRCP can accurately detect strictures in 80.5% cases and can't able to detect in 19.5% cases. MRCP fails to diagnose one ERCP positive case. There was signicant association found between MRCP and ERCP in detection of strictures. Sensitivity, specicity, PPV, NPV and accuracy of MRCP in diagnosing strictures when compared to ERCP were 96.7%, 84.7%, 78.3%, 97.5% and 89.5% respectively. Group 3 (malignancy): Among 16 patients ERCPpositive for malignancy, MRCPaccurately detected malignancies in 87.5% cases and can't able to detect in 19.5% cases. MRCP fails to diagnose 5 ERCP positive case. There was a signicant association found between MRCP and ERCP in detection of malignancies. Sensitivity, specicity, PPV, NPV and accuracy of MRCP in diagnosing malignancy when compared to ERCP were 73.7%, 96.5%, 87.5%, 96.5% and 90.8% respectively. CONCLUSIONS: Sensitivity was high for MRCP in detecting stones 97.4% and strictures 96.7% when compared to malignancies 73.7%. Specicity was high for MRCPin detecting malignancies 96.5% when compared to stones 83.8% and strictures 84.7%. PPVwas high for MRCPin detecting stones 86.4% and malignancies 87.5% when compared to strictures 78.3%.NPV was high for MRCP in detecting stones 96.8% and malignancies 96.5% and strictures 97.5%.7 MRCP can accurately detect 90.8% cases of stones, 89.5% of strictures and 90.8% cases of malignancies. If MRCP is considered the method of choice for evaluating such patients, it can be possible to save time and cost and to avoid complications due to unnecessary procedures.In conclusion, patients with suspicion of biliary or pancreatic disease, but without a clear aetiological factor, should be referred for MRCP after abdominal US and laboratory tests. ERCP can then be reserved for those patients likely to benet from a therapeutic manoeuvre. So, MRCPcan be an alternative to ERCPat least for diagnosis.