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    Evaluation of Obstructive Jaundice by Ultrasonography With MRCP Correlation

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    Sarbesh Tiwari
    This document evaluates ultrasonography and MRCP for diagnosing obstructive jaundice. It aims to determine the level and cause of obstruction. 39 patients with obstructive jaundice underwent US and MRCP. US correctly determined the level of obstruction in 35 cases (90% sensitivity) and cause in 79% of cases. MRCP correctly determined level in 38 cases (95% sensitivity) and cause in 93% of cases. The study concludes US is excellent for screening obstructive jaundice while MRCP is highly accurate for determining the etiology of obstruction in a non-invasive manner.

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    Evaluation of Obstructive Jaundice by Ultrasonography With MRCP Correlation

    Uploaded by

    Sarbesh Tiwari
    230 views32 pages
    This document evaluates ultrasonography and MRCP for diagnosing obstructive jaundice. It aims to determine the level and cause of obstruction. 39 patients with obstructive jaundice underwent US and MRCP. US correctly determined the level of obstruction in 35 cases (90% sensitivity) and cause in 79% of cases. MRCP correctly determined level in 38 cases (95% sensitivity) and cause in 93% of cases. The study concludes US is excellent for screening obstructive jaundice while MRCP is highly accurate for determining the etiology of obstruction in a non-invasive manner.

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    EVALUATION OF OBSTRUCTIVE JAUNDICE BY ULTRASONOGRAPHY WITH MRCP CORRELATION

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    This document evaluates ultrasonography and MRCP for diagnosing obstructive jaundice. It aims to determine the level and cause of obstruction. 39 patients with obstructive jaundice underwent US and MRCP. US correctly determined the level of obstruction in 35 cases (90% sensitivity) and cause in 79% of cases. MRCP correctly determined level in 38 cases (95% sensitivity) and cause in 93% of cases. The study concludes US is excellent for screening obstructive jaundice while MRCP is highly accurate for determining the etiology of obstruction in a non-invasive manner.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    230 views32 pages

    Evaluation of Obstructive Jaundice by Ultrasonography With MRCP Correlation

    Uploaded by

    Sarbesh Tiwari
    This document evaluates ultrasonography and MRCP for diagnosing obstructive jaundice. It aims to determine the level and cause of obstruction. 39 patients with obstructive jaundice underwent US and MRCP. US correctly determined the level of obstruction in 35 cases (90% sensitivity) and cause in 79% of cases. MRCP correctly determined level in 38 cases (95% sensitivity) and cause in 93% of cases. The study concludes US is excellent for screening obstructive jaundice while MRCP is highly accurate for determining the etiology of obstruction in a non-invasive manner.

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    EVALUATION OF OBSTRUCTIVE JAUNDICE BY ULTRASONOGRAPHY WITH MRCP CORRELATION

    Sarbesh Tiwari P.G.T , Radiodiagnosis Assam Medical college & Hospital Dibrugarh

    INTRODUCTION
    Jaundice, or icterus, is a yellowish discoloration of

    tissue resulting from the deposition of bilirubin


    Causes
    Obstructive (surgical) Non obstructive (medical) categories

    Surgical jaundice has been defined as ductal

    pathology potentially correctable by surgery regardless of whether the biliary system was dilated
    2

    AIMS AND OBJECTIVES


    i. To evaluate the level and cause of

    obstruction in patients with obstructive jaundice.


    ii. To correlate the Ultrasonographic findings

    with the MRCP findings.

    MATERIALS AND METHOD


    Study period

    -- From June 2011, ongoing study.

    Study Place

    -- Department of Radiodiagnosis , Assam medical college & Hospital --39

    Sample size

    MATERIALS AND METHOD

    Inclusion criteria
    Any patients with obstructive jaundice

    confirmed by biochemical investigations and morphological criteria.


    Exclusion Criteria
    All patients with medical jaundice and

    cirrhosis of liver
    Claustrophobic/patients with breath holding

    difficulties were excluded from the study


    5

    MATERIALS AND METHOD

    MACHINES
    USG machine Seimen Acusion Antres 5.0 ultrasound system. MRCP Seimens Avanto 1.5 T Germany by using a phased array multicoil
    Conventional T1 and T2 sequences (in axial plane) followed by T2 haste in axial and coronal plane and thin-section 3D T2-fast spin echo images were taken
    6

    MATERIALS AND METHOD

    A final definitive diagnosis was done by


    Operative findings on surgery with

    histopathological examination wherever possible


    Follow up studies when treatment was conservative.

    RESULTS AND OBSERVATIONS

    RESULTS AND OBSERVATIONS

    AGE DISTRIBUTION

    RESULTS AND OBSERVATIONS

    SEX DISTRIBUTION

    Male 17 Female - 22

    RESULTS AND OBSERVATIONS

    BENIGN vs MALIGNANT

    BENIGN 24 MALIGNANT - 15

    RESULTS AND OBSERVATIONS

    Benign causes

    RESULTS AND OBSERVATIONS

    Malignant causes

    RESULTS AND OBSERVATIONS

    LEVEL OF OBSTRUCTION AS DETERMINED BY USG


    Final Diagnosis (Confirmed Diagnosis)
    Porta Hepatis

    Number (n) Cases


    13

    USG DIAGNOSIS Correct Indeterminate


    13 0

    Incorrect
    0

    Suprapancreatic
    Intrapancreatic TOTAL

    16
    10 39

    14
    8 35

    1
    2 3

    1
    0 1

    RESULTS AND OBSERVATIONS

    LEVEL OF OBSTRUCTION AS DETERMINED BY MRCP


    Final Dianosis (confirmed diagnosis) Porta Hepatis Number (n) Correct Cases 13 13 MRCP DIAGNOSIS

    Indeterminate Incorrect
    0 0

    Suprapancreatic Intrapancreatic
    TOTAL

    16 10
    39

    15 9
    37

    1 1
    2

    0 0
    0

    15

    RESULTS AND OBSERVATIONS

    LEVELS OF OBSTRUCTION

    CAUSES DIAGNOSED BY USG


    FINAL DIAGNOSIS CHOLEDOCHOLITHIASIS GB NEOPLASM CHOLANGIO CARCINOMA PERIAMPULLARY NUMBER (N) USG DIAGNOSIS CORRECT

    RESULTS AND OBSERVATIONS

    INCORRECT INDETERMINATE

    14

    12

    7 4
    4

    7 2
    3

    0 1
    1

    0 1
    0

    BENIGN STRICTURE
    CHOLEDOCHAL CYST MIRIZZI SYNDROME PORTAL BILOPATHY TOTAL

    6
    2 1 1 39

    4
    2 0 0 30

    0
    0 0 0 3

    2
    0 1 1 6

    CAUSES DIAGNOSED BY MRCP


    FINAL DIAGNOSIS NUMBER (N) MRCP DIAGNOSIS

    RESULTS AND OBSERVATIONS

    CORRECT INCORRECT INDETERMINATE

    CHOLEDOCHOLITHIASIS GB NEOPLASM CHOLANGIO CARCINOMA PERIAMPULLARY BENIGN STRICTURE CHOLEDOCHAL CYST

    14

    13

    7 4
    4 6 2

    7 3
    4 5 2

    0 1
    0 0 0

    0 0
    0 1 0

    MIRIZZI SYNDROME
    PORTAL BILOPATHY TOTAL

    1 1
    39

    1 1
    36

    0 0
    1

    0 0
    2

    RESULTS AND OBSERVATIONS

    CASES

    CASE 1: GB neck mass with Infiltration


    A 39 yrs female presented with jaundice and upper abdominal discomfort

    CASE 2: CHOLEDOCHOLITHIASIS
    A 46 yrs female presenting with acute abdomen

    CASE 3 :Hilar cholangiocarcinoma


    A 70 yrs male presenting with painless jaundice and pruritus.

    CASE 4 : Periampullary carcinoma


    A 52 yrs male presenting with increasing jaundice and upper abdominal vague pain

    CASE 5: Benign stricture of CBD


    A 35 yrs female after cholecystectomy

    CASE 6: Choledochal cyst


    A 8 yrs girl presenting with intermittent jaundice

    DISCUSSION
    Peak age group was 4th to 5th decade.
    (Vakil et al: 35yrs-65 yrs)

    F > M. MC site of obstruction - Suprapancreatic part

    CBD (42% cases) followed by porta hepatis (33.3%).

    USG and MRCP were comparative in

    diagnosis of obstruction at level of porta hepatis

    DISCUSSION

    Benign causes totaled 67% of the cases.

    Calculus was the MC cause followed by benign stricture, choledochal cyst, Mirizzi syndrome and portal biliopathy.
    Malignant neoplasms constituted 33% of cases.

    The most common neoplasm causing obstruction was GB carcinoma in our study.

    DISCUSSION

    USG could correctly determine the Level of obstruction in 35 cases

    (sensitivity of 90%) Cause of obstruction in 79% of cases.


    MRCP could correctly determine the
    Level of obstruction in 38 cases

    (sensitivity of 95%) Cause of obstruction in 93 % of cases

    DISCUSSION

    Comparison with previous study


    Study USG Level (%) Cause (%) MRCP Level (%) Cause (%)

    V.Upadhyaya Et al* (2006) Sameer verma et al# (2011) Present study

    83.5

    77

    95.45

    87.50

    91.8

    87.3

    91

    90

    90

    79

    95

    93

    * IJRI , 16:4, November 2006 ( V. upadhaya et al) # The Internet Journal of Tropical Medicine

    CONCLUSION
    Ultrasound remains an excellent screening

    modality for determining obstruction in a patient with jaundice


    MR cholangiography was found to be highly accurate non invasive methode in the detection of various etiology of obstruction.

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