Accuracy and timeliness of an abbreviated emergency department MRCP protocol for choledocholithiasis
PURPOSE: To determine the diagnostic accuracy and time savings of an abbreviated magnetic resonance cholangiopancreatography (A-MRCP) protocol for detecting choledocholithiasis in patients visiting the emergency department (ED) for suspected biliary obstruction.
METHODS AND MATERIALS: This retrospective study evaluated adult patients (ages 18+ years) visiting an academic Level 1 trauma center between January 1, 2016, and December 31, 2017, who were imaged with MRCP for suspected biliary obstruction. Patients were scanned with either a four-sequence A-MRCP protocol or a conventional eight-sequence MRCP (C-MRCP) protocol. Image acquisition and MRI room time were compared. The radiology report was used to determine whether a study was limited by motion or prematurely aborted, as well as for the presence of pertinent biliary findings. Diagnostic accuracy of A-MRCP studies were compared with any available endoscopic retrograde cholangiopancreatography (ERCP) report within 30 days.
RESULTS: One hundred sixteen patients met inclusion criteria; 85 were scanned with the A-MRCP protocol (45.9% male, mean 57.4 years) and 31 with the C-MRCP protocol (38.7% male, mean 58.3 years). Mean image acquisition time and MRI room time for the A-MRCP protocol were significantly lower compared to those for the C-MRCP protocol (16 and 34 min vs. 42 and 61 min, both p < 0.0001). Choledocholithiasis was seen in 23.5% of A-MRCP cases and 19.4% of C-MRCP cases. Non-biliary findings were common in both cohorts, comprising 56.5% of A-MRCP cases and 41.9% of C-MRCP cases. 44.7% of A-MRCP patients received subsequent (diagnostic or therapeutic) ERCP (mean follow-up time 3 days), in which A-MRCP accurately identified choledocholithiasis in 86.8% of cases, with sensitivity of 85%, specificity of 88.9%, positive predictive value (PPV) of 89.5%, and negative predictive value (NPV) of 84.2%. In comparison, 38.7% of C-MRCP patients underwent ERCP (mean follow-up of 2.3 days) with an accuracy of 91.7%, sensitivity of 80%, specificity of 100%, PPV of 100%, and NPV of 87.5%. Only 4.7% of A-MRCP exams demonstrated motion artifact vs. 12.9% of C-MRCP exams. One study was prematurely aborted due to patient discomfort in the A-MRCP cohort while no studies were terminated in the C-MRCP cohort.
CONCLUSION: An abbreviated MRCP protocol to evaluate for choledocholithiasis provides significant time savings and reduced motion artifact over the conventional MRCP protocol while providing similar diagnostic accuracy.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2019 |
|---|---|
| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:26 |
|---|---|
| Enthalten in: |
Emergency radiology - 26(2019), 4 vom: 27. Aug., Seite 427-432 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Tso, David K [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Biliary obstruction |
|---|
| Anmerkungen: |
Date Completed 20.01.2020 Date Revised 25.02.2020 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1007/s10140-019-01689-w |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM296503185 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM296503185 | ||
| 003 | DE-627 | ||
| 005 | 20231225085959.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2019 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1007/s10140-019-01689-w |2 doi | |
| 028 | 5 | 2 | |a pubmed24n0988.xml |
| 035 | |a (DE-627)NLM296503185 | ||
| 035 | |a (NLM)31030393 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Tso, David K |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Accuracy and timeliness of an abbreviated emergency department MRCP protocol for choledocholithiasis |
| 264 | 1 | |c 2019 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 20.01.2020 | ||
| 500 | |a Date Revised 25.02.2020 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a PURPOSE: To determine the diagnostic accuracy and time savings of an abbreviated magnetic resonance cholangiopancreatography (A-MRCP) protocol for detecting choledocholithiasis in patients visiting the emergency department (ED) for suspected biliary obstruction | ||
| 520 | |a METHODS AND MATERIALS: This retrospective study evaluated adult patients (ages 18+ years) visiting an academic Level 1 trauma center between January 1, 2016, and December 31, 2017, who were imaged with MRCP for suspected biliary obstruction. Patients were scanned with either a four-sequence A-MRCP protocol or a conventional eight-sequence MRCP (C-MRCP) protocol. Image acquisition and MRI room time were compared. The radiology report was used to determine whether a study was limited by motion or prematurely aborted, as well as for the presence of pertinent biliary findings. Diagnostic accuracy of A-MRCP studies were compared with any available endoscopic retrograde cholangiopancreatography (ERCP) report within 30 days | ||
| 520 | |a RESULTS: One hundred sixteen patients met inclusion criteria; 85 were scanned with the A-MRCP protocol (45.9% male, mean 57.4 years) and 31 with the C-MRCP protocol (38.7% male, mean 58.3 years). Mean image acquisition time and MRI room time for the A-MRCP protocol were significantly lower compared to those for the C-MRCP protocol (16 and 34 min vs. 42 and 61 min, both p < 0.0001). Choledocholithiasis was seen in 23.5% of A-MRCP cases and 19.4% of C-MRCP cases. Non-biliary findings were common in both cohorts, comprising 56.5% of A-MRCP cases and 41.9% of C-MRCP cases. 44.7% of A-MRCP patients received subsequent (diagnostic or therapeutic) ERCP (mean follow-up time 3 days), in which A-MRCP accurately identified choledocholithiasis in 86.8% of cases, with sensitivity of 85%, specificity of 88.9%, positive predictive value (PPV) of 89.5%, and negative predictive value (NPV) of 84.2%. In comparison, 38.7% of C-MRCP patients underwent ERCP (mean follow-up of 2.3 days) with an accuracy of 91.7%, sensitivity of 80%, specificity of 100%, PPV of 100%, and NPV of 87.5%. Only 4.7% of A-MRCP exams demonstrated motion artifact vs. 12.9% of C-MRCP exams. One study was prematurely aborted due to patient discomfort in the A-MRCP cohort while no studies were terminated in the C-MRCP cohort | ||
| 520 | |a CONCLUSION: An abbreviated MRCP protocol to evaluate for choledocholithiasis provides significant time savings and reduced motion artifact over the conventional MRCP protocol while providing similar diagnostic accuracy | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Biliary obstruction | |
| 650 | 4 | |a Choledocholithiasis | |
| 650 | 4 | |a Emergency radiology | |
| 650 | 4 | |a MRCP | |
| 650 | 7 | |a Contrast Media |2 NLM | |
| 700 | 1 | |a Almeida, Renata R |e verfasserin |4 aut | |
| 700 | 1 | |a Prabhakar, Anand M |e verfasserin |4 aut | |
| 700 | 1 | |a Singh, Ajay K |e verfasserin |4 aut | |
| 700 | 1 | |a Raja, Ali S |e verfasserin |4 aut | |
| 700 | 1 | |a Flores, Efren J |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Emergency radiology |d 1997 |g 26(2019), 4 vom: 27. Aug., Seite 427-432 |w (DE-627)NLM093746342 |x 1438-1435 |7 nnns |
| 773 | 1 | 8 | |g volume:26 |g year:2019 |g number:4 |g day:27 |g month:08 |g pages:427-432 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1007/s10140-019-01689-w |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 26 |j 2019 |e 4 |b 27 |c 08 |h 427-432 | ||