Ultrasonographic prediction of the causes & level of obstruction in diagnosis of obstructive jaundice
- SP Pandit, M. Panthi
Background: Biliary disorders are one of the common problems routinely seen in clinical practice. Hence, the study was carried out to compare two non-invasive, non-radiating modalities (ultrasonography [USG] and magnetic resonance cholangiopancreatography [MRCP]) for the evaluation of biliary duct system and to compare the diagnostic accuracy between USG and MRCP in the patients suspected of obstructive biliary tract pathology. Materials and Methods: Patients suspected of biliary pathology were examined first by real time USG with convex (3-5 MHz) transducer, then MRCP with 1.5 Tesla magnetic resonance imaging. Result: Of 50 patients majority of the case were found 51-60 year age groups. Among 60% were female, and 40% were male. Predominant symptoms in the study group were jaundice in 46 patients (92%). Overall malignant obstruction was more common then benign (68% vs. 32%). USG was found sensitive in 81.2% and specific in 100% cases while MRCP was sensitive in 93.7% and specific in 97% in benign lesion as a cause of obstruction while among malignant lesion as a cause of obstruction USG was found 94.1% sensitive and 68.7% specific and MRCP was 97% sensitive and 93.7% specific. On USG, intra-hepatic biliary radicals were found to be dilated in all except one patient i.e. 98% while it was 100% on MRCP. Overall 10 cases were falsely diagnosed by USG while only 2 cases were falsely diagnosed by MRCP among all 50 cases. Conclusion: USG is considered the first choice option in the diagnostic imaging of obstructive biliary disease. However, owing to its low sensitivity in most of the benign stenosis and distal common bile duct disease, where the clinical and laboratory suspicion is strong and unsupported by ultrasound and/or in the presence of conditions affecting ultrasound performance, and for a thorough staging evaluation of malignancy, MRCP is highly accurate and superior diagnostic modality in establishing diagnosis of obstructive biliary pathologies.