Intrahepatic duct calculi. Role of imaging compared with surgical and histopathological finding

PURPOSE: To determine the accuracy of imaging tools in the evaluation of intrahepatic duct stones in recurrent pyogenic cholangitis. MATERIALS AND METHODS: Sixty patients with recurrent pyogenic cholangitis underwent MRC and ERCP followed by surgery. MRC and ERCP images were interpreted independently by radiologist and gastroenterologist respectively before surgery and focused on intra bile duct dilatation, stones, strictures and parenchymalabnormalities.These observations were compared with final diagnosis obtained at surgery, histopathological findings, removal of stones and intraoperative cholangiography findings. RESULTS: At final diagnosis 111 intrahepatic segments were diseased in 56 patients. MRC depicted disease in 106(95.5%) segments and ERCP in 67 (60.4%) segments (P < 0.001). Left lateral and right posterior segments accounted for 76.5% of 111 segments, 62 segments were involved in left lobe and 49 segments in right lobe. MRC accurately identified involvement in 60 of 62 (96.8%) segments of left lobe but ERCP depicted disease in 44 (71%) segments (P < 0.001). In right lobe segments, the sensitivity of MRC for correct diagnosis was 46 of 49 (93.9%) segments and that of ERCP in 23 of 49 (46.9%) segments (P< 0.001). MRC was significantly superior to ERCP (P=0.002) CONCLUSION: MRC is superior to ERCP for accurate topographic evaluation of intrahepatic duct stones in recurrent pyogenic cholangitis. Delineates the entire biliary tract regardless of the presence of strictures, is non¬invasive, requires no contrast material and is devoid of complications. ERCP (P = 0.002) is superior for identification of dilatation, stones and stricture in the left and right hepatic ducts.