Unveiling Hidden Diagnoses: The Prevalence and Clinical Impact of Extra-biliary Findings on Magnetic Resonance Cholangiopancreatography

TL;DR

This study shows that over half of MRCP scans reveal extra-biliary issues, with some leading to new cancer diagnoses, suggesting the need for improved reporting methods.

Contribution

The study quantifies the prevalence and clinical impact of extra-biliary findings on MRCP scans in a large cohort.

Findings

Over 58% of MRCPs had at least one extra-biliary finding.

2.6% of patients had newly diagnosed malignancies following urgent follow-up.

Common extra-biliary findings included renal cysts, hepatic cysts, and pleural effusions.

Abstract

Background

Magnetic resonance cholangiopancreatography (MRCP) is being increasingly employed for evaluating the biliary tree. This imaging technique has the potential to uncover extra-biliary abnormalities that may necessitate additional urgent investigations. The primary aim of this study was to determine the prevalence of extra-biliary findings on MRCPs. A secondary aim was to evaluate the subsequent need for further investigations and their outcomes.

Methods

This retrospective cohort study reviewed consecutive MRCPs performed on adult patients at a single centre between November 2020 and September 2022. Patient demographics, MRCP indications, results including extra-biliary findings, and subsequent investigations and outcomes were analysed using electronic case notes.

Results

A total of 1,018 MRCPs were included in this study; 617 (60.6%) were for female patients, and the median age was 64 years (IQR: 50-75). Specifically, 648 (63.7%) were inpatient, 418 (41.1%) were urgent, 592 (58.2%) had at least one extra-biliary finding, and 96 (9.4%) required urgent follow-up investigations, with 26 (2.6%) new diagnoses of malignancy. Additionally, 213 (20.9%) had renal cysts, 118 (11.6%) had hepatic cysts, 69 (6.7%) had pancreatic cysts, 28 (2.8%) had liver cirrhosis, 23 (2.3%) had peripancreatic collection(s), 42 (4.1%) had a hiatus hernia, 79 (7.8%) had pleural effusion(s), 46 (4.5%) had splenomegaly, and 2.6% (n=26) had identified diverticular disease.

Conclusions

Over half of the MRCPs performed identified at least one extra-biliary finding. Among those requiring urgent follow-up, over 25% led to newly diagnosed malignancies. This underscores MRCP's high sensitivity, extending beyond biliary conditions to effectively detect extra-biliary pathologies. Our findings support consideration of adopting a structured proforma for reporting MRCPs.

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