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First published online November 24, 2008
British Journal of Radiology (2009) 82, 279-285
© 2009 British Institute of Radiology
doi: 10.1259/bjr/88591536
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British Journal of Radiology 82 (2009),279-285 ©2009 The British Institute of Radiology

The role of MR cholangiopancreatography in the evaluation of pregnant patients with acute pancreaticobiliary disease

A OTO, MD 1,2 R ERNST, MD 1,3 L GHULMIYYAH, MD 4 D HUGHES, MD 1 G SAADE, MD 4 and G CHALJUB, MD 1

1 Department of Radiology, University Texas Medical Branch at Galveston, Galveston, Texas 77555, 2 Department of Radiology, The University of Chicago, Chicago, Illinois 60637, 3 MD Anderson Cancer Center, Houston, Texas 77030, and 4 Department of Obstetrics and Gynecology, University Texas Medical Branch at Galveston, Galveston, Texas 77555, USA

Correspondence: Dr Aytekin Oto, Department of Radiology, The University of Chicago, 5841 South Maryland Avenue, MC 2026, Chicago, IL 60637, USA. E-mail: aoto{at}radiology.bsd.uchicago.edu

This study aimed to determine the usefulness of MR cholangiopancreatography (MRCP) in the evaluation of pregnant patients with acute pancreaticobiliary disease and its additional value over ultrasound. MRI studies of pregnant patients who were referred because of acute pancreaticobiliary disease were included. MR images and patient charts were reviewed retrospectively to determine clinical outcome and the results of other imaging studies. 18 pregnant patients underwent MRCP because of right upper quadrant pain (n = 6), pancreatitis (n = 9), cholangitis (n = 1) or jaundice (n = 2). 15 patients were also evaluated with ultrasound. Biliary dilatation was detected in eight patients by ultrasound, but the cause of biliary dilatation could not be determined by ultrasound in seven patients. MRCP demonstrated the aetiology in four of these patients (choledocholithiasis (n = 1), Mirizzi syndrome (n = 1), choledochal cyst (n = 1) and intrahepatic biliary stones (n = 1)) and excluded obstructive pathology in the other four patients. MRCP was unremarkable in the seven patients who had no biliary dilatation on ultrasound. Three patients underwent only MRCP; two had choledocholithiasis and one cholelithiasis and pancreatitis. Choledocholithiasis diagnosed with MRCP (n = 3) was confirmed by endoscopic retrograde cholangiopancreatography. Mirizzi syndrome (n = 1) and a choledochal cyst (n = 1) were confirmed by surgery. The patients with normal MRCP (n = 12) and one patient with intrahepatic stones improved with medical treatment. MRCP appears to be a valuable and safe technique for the evaluation of pregnant patients with acute pancreaticobiliary disease. Especially when ultrasound shows biliary dilatation, MRCP can determine the aetiology and save the patient from unnecessary endoscopic retrograde cholangiopancreatography by excluding a biliary pathology.






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