For diagnosis of CBD stones, MRCP has a reported sensitivity ranging from 77% to 88%, specificity between 50% to 72%, accuracy of 83%, positive predictive value between 87% to 90%, and negative predictive value between 27% to 72%, as compared to the gold standard of ERCP [57,58]. MRCP is less morbid than ERCP imaging; however, ERCP imaging offers the potential for intervention (CBD stone extraction or biopsy of an obstructing lesion). MRI offers similar sensitivity and specificity to CT imaging for the presurgical evaluation and staging of pancreatic adenocarcinoma [54]. Both MRI and CT are superior to ERCP and EUS for the staging of pancreaticobiliary malignancies (including cholangiocarcinomas and pancreatic head/body/tail malignancies), as MRI and CT enable cross-sectional imaging of all the organs of the upper abdomen and can detect vascular encasement and metastatic disease, whereas ERCP is limited to imaging of the biliary ductal system only, and EUS is limited to evaluation of regions within its small field of view [91-93]. MRI performed with diffusion sequences and gadoxetate disodium is more sensitive than CT for the detection of liver metastases from pancreaticobiliary malignancies [94-96]. The use of MRCP may decrease the number of ERCP examinations obtained prior to elective cholecystectomy (if no CBD stone is seen at the time of MRCP and there is no clinical suspicion for biliary obstruction, then surgeons may choose to proceed directly to cholecystectomy) [26,61]. MRCP is valuable in the clinical situation of failed ERCP [26,53], in patients who are too sick to undergo ERCP [97], and in patients with hilar biliary obstructions that are due to ductal tumor or periductal compression [51,52,63,98-101]. MRCP offers additive value over US in pregnant patients with suspected pancreaticobiliary disease and is more sensitive than US for determining the cause of biliary obstruction when dilated bile ducts are seen on US [61].
Jaundice. For diagnosis of CBD stones, MRCP has a reported sensitivity ranging from 77% to 88%, specificity between 50% to 72%, accuracy of 83%, positive predictive value between 87% to 90%, and negative predictive value between 27% to 72%, as compared to the gold standard of ERCP [57,58]. MRCP is less morbid than ERCP imaging; however, ERCP imaging offers the potential for intervention (CBD stone extraction or biopsy of an obstructing lesion). MRI offers similar sensitivity and specificity to CT imaging for the presurgical evaluation and staging of pancreatic adenocarcinoma [54]. Both MRI and CT are superior to ERCP and EUS for the staging of pancreaticobiliary malignancies (including cholangiocarcinomas and pancreatic head/body/tail malignancies), as MRI and CT enable cross-sectional imaging of all the organs of the upper abdomen and can detect vascular encasement and metastatic disease, whereas ERCP is limited to imaging of the biliary ductal system only, and EUS is limited to evaluation of regions within its small field of view [91-93]. MRI performed with diffusion sequences and gadoxetate disodium is more sensitive than CT for the detection of liver metastases from pancreaticobiliary malignancies [94-96]. The use of MRCP may decrease the number of ERCP examinations obtained prior to elective cholecystectomy (if no CBD stone is seen at the time of MRCP and there is no clinical suspicion for biliary obstruction, then surgeons may choose to proceed directly to cholecystectomy) [26,61]. MRCP is valuable in the clinical situation of failed ERCP [26,53], in patients who are too sick to undergo ERCP [97], and in patients with hilar biliary obstructions that are due to ductal tumor or periductal compression [51,52,63,98-101]. MRCP offers additive value over US in pregnant patients with suspected pancreaticobiliary disease and is more sensitive than US for determining the cause of biliary obstruction when dilated bile ducts are seen on US [61].