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.