Diagnostic Accuracy of MRCP with T2-Weighted Imaging in the Evaluation of Benign and Malignant Biliary Strictures

Abstract

Distinguishing malignant from benign biliary strictures is important for treatment planning and prognosis. This retrospective study evaluated the diagnostic performance of magnetic resonance cholangiopancreatography (MRCP) with T2-weighted imaging in determining the level, cause, and imaging characteristics of benign and malignant biliary strictures. Fifty patients with obstructive jaundice who underwent MRI/MRCP at Tripoli Central Hospital between January 2018 and January 2019 were included. MRCP findings, including ductal dilatation, stricture level, stricture length, wall thickness, suspected cause, and T2 signal intensity, were compared with a composite reference standard based on endoscopic retrograde cholangiopancreatography, operative findings, and biopsy/histopathology results. MRCP detected ductal dilatation in all patients and correctly identified the level of obstruction in all cases. MRI/MRCP correctly determined the cause of obstruction in 48 of 50 patients, giving an overall diagnostic accuracy of 96%. The distal common bile duct was the most frequent obstruction site (56%). The sensitivity and specificity of MRCP for malignant strictures were 94.7% and 96.7%, respectively. Malignant strictures were generally longer (>11 mm) and had thicker walls (>3 mm) than benign strictures. T2 hyperintensity was strongly associated with malignant disease, whereas T2 isointensity was more commonly associated with benign strictures. MRCP with T2-weighted imaging is a reliable non-invasive modality for localizing and characterizing biliary strictures and may help differentiate benign from malignant causes of biliary obstruction.