# Comparative Diagnostic Accuracy of Clinical Assessment, Computed Tomography (CT), and Magnetic Resonance Imaging With Magnetic Resonance Cholangiopancreatography (MRI/MRCP) in Evaluating Common Bile Duct Stones

## TL;DR

This study finds that MRI/MRCP is the most accurate non-invasive method for diagnosing common bile duct stones compared to CT and clinical assessment.

## Contribution

The study provides a direct comparative analysis of diagnostic methods for choledocholithiasis using a large patient cohort.

## Key findings

- MRI/MRCP had the highest sensitivity (92.7%), specificity (91.9%), and accuracy (92.3%) for detecting CBD stones.
- CT and clinical assessment showed significantly lower diagnostic accuracy compared to MRI/MRCP.
- MRI/MRCP's AUC (0.95) was significantly higher than CT (0.83) and clinical assessment (0.81).

## Abstract

Purpose: To determine the most effective method for diagnosing common bile duct (CBD) stones, this research retrospectively compares the diagnostic accuracy of initial clinical evaluation, computed tomography (CT), and magnetic resonance imaging with magnetic resonance cholangiopancreatography (MRI/MRCP). The goal is to identify the optimal non-invasive strategy to guide patient management and prevent unnecessary invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP). An accurate diagnosis of choledocholithiasis is essential for proper patient care.

Materials and methods: This single-center, retrospective analysis involved 691 adult patients who were under evaluation for suspected choledocholithiasis. The effectiveness of clinical assessment, multidetector CT, and MRI/MRCP was measured against definitive diagnoses obtained from surgical or procedural findings. For each diagnostic method, the study calculated sensitivity, specificity, accuracy, and the area under the receiver operating characteristic curve (AUC).

Results: CBD stones were present in 311 of the 691 patients, a prevalence of 45%. MRI/MRCP was the most effective diagnostic tool, with a sensitivity of 92.7%, a specificity of 91.9%, and an accuracy of 92.3%. In comparison, CT scans yielded a sensitivity of 73.2%, a specificity of 82.9%, and an accuracy of 78.3%. Clinical assessment resulted in a sensitivity of 71.1%, a specificity of 87.1%, and an accuracy of 80%. The AUC for MRI/MRCP (0.95) was markedly higher than that for both CT (0.83; p<0.001) and clinical assessment (0.81; p<0.001). There was no significant difference in the diagnostic performance between CT and clinical assessment (p=0.45).

Conclusion: For the non-invasive identification of CBD stones, MRI/MRCP provides superior diagnostic accuracy compared to both CT and clinical evaluation. It is recommended as the top imaging choice for patients with suspected choledocholithiasis.