DIAGNOSTIC ACCURACY OF MRCP FOR DETECTING CHOLEDOCOLITHIASIS IN PATIENTS PRESENTED WITH OBSTRUCTIVE JAUDICE KEEPING ERCP FINDING AS GOLD STANDARD

Abstract

Objective:
To evaluate the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) in detecting choledocholithiasis (common bile duct stones) in patients with obstructive jaundice, using endoscopic retrograde cholangiopancreatography (ERCP) as the reference standard.

Design:
A cross-sectional validation study.

Place & Duration of Study:

Department of Radiology, Bacha Khan Medical College/Mardan Medical Complex, Mardan, from December 2024 to April 2025.

Methodology:
A total of 115 patients aged 16–65 years presenting with features of obstructive jaundice and cholestatic liver function tests were enrolled. All patients underwent MRCP followed by ERCP. MRCP scans were interpreted by a consultant radiologist blinded to ERCP results. The presence of choledocholithiasis on MRCP was defined as a signal void or filling defect within the common bile duct, while ERCP findings were considered the gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy of MRCP were calculated with ERCP as the reference.

Results:
The mean age of patients was 48 ± 13 years, and 56% were female. ERCP confirmed choledocholithiasis in 50 patients (43.5%). MRCP correctly identified 45 of these (true positives) and missed 5 (false negatives), yielding a sensitivity of 90.0%. Among 65 ERCP-negative patients, MRCP correctly ruled out stones in 55 (true negatives) and showed false-positive findings in 10, giving a specificity of 84.6%. The positive predictive value was 81.8%, negative predictive value 91.7%, and overall diagnostic accuracy 87.0%. No statistically significant differences in diagnostic performance were observed across subgroups stratified by age, sex, or duration of symptoms (p>0.05).

Conclusion:
MRCP demonstrated high diagnostic accuracy in detecting choledocholithiasis in patients with obstructive jaundice. Given its excellent sensitivity and negative predictive value, MRCP serves as a reliable, non-invasive tool for screening and triaging patients for therapeutic ERCP, potentially reducing unnecessary invasive procedures. However, positive MRCP findings should be confirmed with ERCP for definitive diagnosis and treatment.