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Table 3 Study characteristics

From: MRCP compared to diagnostic ERCP for diagnosis when biliary obstruction is suspected: a systematic review

Study, country

Sample selection

Comparison (type of MRCP and reference tests used)

Description of patients and procedures; study period

Time between ERCP and MRCP

Adamek et al, 1998; Germany[9]

Not reported

RARE and HASTE MRCP were compared with ERCP

86 patients entered the study; 8 were excluded due to biliary-enteric anastomoses, of the remaining 78, 16 had unsatisfactory ERCP, 2 had unsatisfactory MRCP (claustrophobia) leaving 60 patients who had both January-December 1996

Not reported

Angulo et al, 2000; USA[11]

Not reported

Fast spin echo pulse sequence compared with ERCP and PTC

Initially 74, 1 did not receive MRCP due to claustrophobia, 73 had MRCP, 68 had ERCP, 2 had PTC and 3 had neither Study period not stated

MRCP performed within 24 hours preceding the scheduled ERCP

Barish et al, 1995; USA[12]

Random selection from referrals

3D TSE MRCP compared with ERCP and PTC

30 patients initially selected, one patient did not receive MRCP due to the presence of ascitic fluid in the upper abdomen; three had PTC due to failed ERCP, 8 of the 29 patients did not have ERCP or PTC Study period not reported

ERCP was performed 8 hours after MRCP

Calvo et al, 2002; Spain[13]

Not reported

Two HASTE sequences MRCP compared with ERCP

116 patients with suspected biliopancreatic pathology initially, of these 61 patients were selected with suspected choledocholithiasis, failure in one patient for ERCP November 1996-February 1998

MRCP within 72 hours before ERCP

Chan et al, 1996; Hong Kong[14]

Consecutive sample

T2-weighted turbo spin-echo sequence (non-breath-hold, fat-suppressed) MRCP compared with ERCP

47 had MRCP, 45 had ERCP (two failures) May-August 1995

ERCP within 5 hours after MRCP

Demartines et al, 2000; Switzerland[15]

Not reported

3 acquisition techniques of MRCP were used including T2/T1 weighted, single-shot turbo spin echo and half-Fourier acquisition single-shot turbo spin echo heavy sequence compared with ERCP (high-risk patients) or intraoperative cholangiography (moderate risk patients)

40 patients received ERCP and MRCP and 30 received IOC and MRCP April 1997-September 1998

Not reported

Dwerryhouse et al, 1998; UK[16]

Not reported

T2 weighted TSE with non-breath-holding MRCP compared with ERCP and POC

Initially 405 patients who underwent laparoscopic cholecystectomy, of these 278 had no known risk factors for CB stones, 87 underwent early ERCP and were excluded. 40 patients with risk factors for CBD stones underwent MRCP. 2 patients had failed MRCP due to claustrophobia, ERCP was unsuccessful in 4 patients who then had peroperative cholangiography. February 1996 – January 1998

All patients underwent ERCP within 1 week after ERCP

Guibaud et al, 1995; Canada[18]


2D FSE MRCP compared with ERCP, PTC, T-tube cholangiography, surgery and autopsy

198 patients initially of which 72 were excluded due to no proof of bile duct obstruction (n = 42), unsuccessful ERCP (n = 12), unsuccessful MRCP due to claustrophobia (n = 6), inadequate ERCP (n = 10) or MRCP (n = 2) leaving 126 patients September 1992-March 1993

Time between MRCP and final diagnosis was less than 6 hours in 105 cases, less than 1 week in 15 cases and more than 1 week in six cases

Holzknecht et al, 1998; Germany[20]

Consecutive sample

RARE and half-Fourier RARE MRCP compared with ERCP

66 patients were eligible, 2 were excluded because of pacemakers, 3 had failed ERCP after MRCP leaving 61 patients who had both MRCP and ERCP June 1995 to April 1996

MRCP performed before ERCP (patients were due to have ERCP within the next 2 days)

Laokpessi et al, 2001; France[21]

Consecutive sample

FSE and T2 heavily weighted single-shot FSE sequences with fat suppression MRCP compared with ERCP or intraoperative cholangiography (IOC)

Initially 166 inpatients but only 147 patients had MRCP, of these 101 had ERCP and 45 had IOC and cholecystectomy. Those in group receiving ERCP had a past history of cholecystectomy or had a high surgical or anaesthetic risk. 21 removed from study for: refusal to sign protocol (n = 3), refusal to undergo MRCP (n = 4) or ERCP (n = 7), excessive time between MRCP and final diagnosis (n = 7) November 1997-December 1999

Average time between MRCP and final diagnosis 10 hours (range 3–48 hours) if longer than 48 hours between MRCP and final diagnosis, patients were removed from the study

Lee et al, 1997; South Korea[22]

Consecutive sample

3D steady-state free-precession MRCP compared with ERCP

71 patients of which 25 were excluded (8 because ERCP was not performed, 15 who were evaluated for intrahepatic stones, 1 for peripheral type of intrahepatic cholangiocarcinoma, 1 suspected mucinous ductal ectasia of the pancreas) leaving 46 patients who had both MRCP and ERCP January-March 1995

33 patients had MRCP before ERCP ranging from 6 hours to 5 days. The remaining 31 patients had ERCP first ranging from 3 to 16 days

Lomanto et al, 1997; Italy[23]

Not reported

T2 weighted TSE sequence MRCP compared with ERCP and PTC

136 patients referred for MRCP, of these 62 had MRCP for choledocholithiasis, (the other 74 were: 48 for stenosis of the biliary tract, 15 with previous hepaticojejunostomy and choledochojejunostomy and 11 with chronic pancreatitis) 60 of these patients had ERCP and 2 had PTC September 1994-October 1995

Not reported

Lomas et al, 1999; UK[24]

Not reported

Hybrid four-shot RARE (FSE) sequence and a single-shot half Fourier RARE sequence compared with ERCP

76 referrals, of these 2 did not have MRCP (one was obese and one was claustrophobic), 5 did not have ERCP (1 died, 1 refused and in 3 patients the operator was unable to cannulate the common bile duct) leaving 69 referrals in 66 patients 18 month period, dates not stated

MRCP took place first within 4 hours of ERCP

Macaulay, et al, 1995; USA[25]


T2-weighted TSE MRCP (non-breath hold) compared with ERCP, PTC and IOC

28 patients initially had MRCP, 24 patients had 28 direct cholangiographic studies (21 had ERCP, 6 had PTC and 1 had IOC) Study period not reported.

ERCP took place within 1–4 hours in 15 patients, 4 were within 5–7 days after MRCP and 1 was 11 days before and another 109 days before MRCP, all PTC studies were within 2 days after MRCP and the 1 IOC preceded MRCP by 5 days.

Regan et al, 1996; USA[26]

Not reported

HASTE MRCP compared with ERCP and sonography

26 patients, 2 had unsuccessful ERCP and one did not have MRCP due to claustrophobia leaving 23 patients

MRCP was performed just before ERCP in 18 patients and within 24 hours in 5 patients

Reinhold et al, 1998; Canada[27]


FSE MRCP compared with ERCP, IOC and surgery

Initially 159 patients of which 49 were excluded due to the following reasons: 34 due to lack of diagnosis, 10 due to unsuccessful ERCP, 3 due to unsuccessful MRCP due to claustrophobia, inadequate ERCP (n = 1) or MRCP (n = 1) leaving a sample of 110 patients. 101 patients had ERCP, 2 had IOC and 7 had surgery. 5 month study period, dates not reported

MRCP was performed first and ERP or equivalent was less than 6 hours later in 97 patients, less than 1 week in 7 patients and more than 1 week in 6 patients

Soto et al, 1996; USA[28]

Randomly recruited

3D FSE MRCP compared with ERCP and PTC

46 patients, 7 of whom were included in Barish et al, 199558, 45 had ERCP and 1 had PTC May 1994-April 1995

ERCP/PTC within 24 hours after MRCP

Soto et al, 2000a; Columbia[30]

Not reported

Breath hold, single shot half-Fourier rapid acquisition and non-breath-hold 3D FSE MRCP compared with ERCP, CT and oral-contrast enhanced CT cholangiography

Initially 68 patients, 12 did not meet inclusion or exclusion criteria, 2 did not have MRCP because of claustrophobia, in 3 ERCP was not attempted or completed leaving 51 patients who had all 4 studies. April 1998-March 1999

MRCP performed within 48 hours before ERCP

Soto et al, 2000b; Columbia[29]

Not reported

3D fast SE, Single section Half-Fourier RARE and multi-section half-Fourier RARE MRCP compared with ERCP

Initially 59 patients, 10 were excluded due to the following reasons: 2 due to MRCP contraindications, 4 because 1 or more of the 3 MRCP sequences could not be completed, and 4 because ERCP could not be completed August 1997-May 1998

MRCP was completed before ERCP within 72 hours

Stiris et al, 2000; Norway[31]

Consecutive sample

HASTE fat suppressed breath-hold MRCP compared with ERCP

50; all patients had both techniques; study period not stated

MRCP performed first followed by ERCP within 12 hours

Sugiyama et al, 1998; Japan[32]

Non consecutive

HASTE MRCP compared with ERCP

187 patients were recruited, 19 underwent only cholangiography or pancreatography on ERCP, in 8 the common channel could not be identified clearly and there was failure of cannulation in 2 patients leaving 159 patients with common bile duct, main pancreatic duct and common channel depicted June 1994-August 1996

MRCP was 0 to 14 days before ERCP

Taylor et al, 2002; Australia[33]

Consecutive sample

HASTE MRCP compared with ERCP, PTC or surgery

Initially 149 procedures (146 patients), MRCP unsuccessful in 8 due to claustrophobia and in 1 patient due to poor image quality, 5 were excluded because MRCP was more than 24 hours before ERCP, in 20 ERCP was unsuccessful (3 had subsequent ERCP, 2 had surgery and 2 had PTC and were included). In two patients ERCP and MRCP were both unsuccessful, leaving 129 patients who had both MRCP and ERCP (or equivalent). November 1998-December 1999

MRCP was performed within 24 hours before ERCP

Textor et al, 2002; Germany[34]

Consecutive sample

3D T2 weighted FSE MRCP compared with ERCP

150 patients initially, of which 146 had successful MRCP, 3 patients with PSC had unsuccessful ERCP and another failed due to a bilidigestive anastomosis January 1996-December 2000

ERCP was performed 1–14 days before MRCP (mean 3.2 days)

Varghese et al, 2000; Ireland[35]

Consecutive sample

T2 weighted 2D multi-slice FSE MRCP compared with ERCP, PTC or IOC

256 patients initially, 64 of which were excluded because ultrasound report or ERCP hard-copy images were not available (n = 30), direct cholangiography was not performed after failed ERCP (n = 22), MRCP not performed due to contraindications (n = 5), MRCP images were of non-diagnostic quality (n = 7), resulting in 191 patients [of these 34 had choledocolithiasis diagnosed by ERCP (n = 29), IOC (n = 3) and PTC (n = 2)] 18 month period, dates not stated

MRCP was performed before ERCP within a period of 4 hours to 2 weeks (mean 18 hours)

Zidi et al, 1999; France[36]

Consecutive sample

Non breath-hold fat suppressed TSE MRCP compared with ERCP (with or without sphincterotomy), endosonography or IOC

70 inpatients were included, 63 had ERCP, 5 had sonography and 2 had IOC 12 month period, dates not reported

MRCP performed within 12 hours before ERCP