J Gandhara Med Dent Sci

October - December 2025

ORIGINAL ARTICLE

DIAGNOSTIC ACCURACY OF MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY

(MRCP) IN THE DIAGNOSIS OF CHOLEDOCHOLITHIASIS TAKING ENDOSCOPIC

RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) AS GOLD STANDARD

Anam Safdar

, Sana Iqbal

, Shandana Khan

ABSTRACT

OBJECTIVES

This study aimed to determine the diagnostic accuracy of magnetic resonance

cholangiopancreatography (MRCP) in choledocholithiasis, using endoscopic

retrograde cholangiopancreatography (ERCP) as the gold standard.

METHODOLOGY

This retrospective, descriptive, cross-sectional study, based on data retrieved

from the hospital information management system, was performed in the

Radiology Department of Northwest General Hospital and Research Centre,

Peshawar. Data from October 15, 2022, to October 15, 2024, was retrieved.

A total of 224 patients fulﬁlling the inclusion criteria were included in the

sample through non-probability consecutive sampling.

RESULTS

The mean age of the sample was 46.8 ± 7.8 years. The sample consisted of

59.4% males and 40.6% females. The mean BMI of the sample was 28.4 ±

2.9kg/m². On MRCP, choledocholithiasis was recorded in 65.6% of patients,

and on subsequent ERCP, it was conﬁrmed in 58.5% of patients. The

sensitivity of MRCP was found to be 90.8%, and the speciﬁcity was 69.9%.

The positive predictive value of the MRCP was 81% and the negative

predictive value was 84.4%. The overall accuracy was 82.1%.

CONCLUSION

MRCP is a highly sensitive and speciﬁc tool for choledocholithiasis, with the

additional advantage of being non-invasive. Eﬀect modiﬁers, such as

diabetes and hypertension, as well as the expertise of the performing

physician, should be included in further studies to determine their eﬀect on

the accuracy of MRCP.

KEYWORDS: Choledocholithiasis, Magnetic Resonance Cholangiopancrea

tography, Endoscopic Retrograde Cholangiopancreatography, Body Mass

Index

How to cite this article

Safdar A, Iqbal S, Khan S. Diagnostic

Accuracy Of Magnetic Resonance

Cholangiopancreatography (Mrcp) in

The Diagnosis Of Choledocholithiasis

Taking Endoscopic Retrograde

Cholangiopancreatography (Ercp) as

Gold Standard. J Gandhara Med Dent

Sci. 2025;12(4):44-47. https://doi.org/10.

Date of Submission: 03-05-2025

Date Revised: 29-08-2025

Date Acceptance: 19-09-2025

Assistant Professor, Department of

Radiology, Northwest General Hospital

& Research Center, Peshawar

Correspondence

Anam Safdar, Senior Registrar

Department of Radiology, Northwest

General Hospital & Research Center,

Peshawar

+92-332-9840175

anamsafdar33@gmail.com

37762/jgmds.12-4.725

INTRODUCTION

Choledocholithiasis refers to the presence of gallstones

in the bile ducts, including the common hepatic duct

and the common bile duct. Its prevalence ranges from

3% to 22%, and the incidence increases with age in

patients with gallstones.

Investigations needed for the

diagnosis & management of choledocholithiasis include

abdominal ultrasound, Computed Tomography (CT),

magnetic resonance cholangiopancreatography (MRCP)

and endoscopic retrograde cholangiopancreatography

(ERCP). The sensitivity and speciﬁcity of ultrasound

for choledocholithiasis are 55% and 90%, respectively,

but its diagnostic capabilities are operator-dependent.

Furthermore, body habitus, bowel gas, and other

artefacts sometimes prevent proper visualisation of the

biliary tract. MDCT was found to have a sensitivity of

44.5%, speciﬁcity of 52.2%, and an accuracy of 46.9%

for the detection of bile duct stones. However, CT scans

expose patients to ionising radiation.

ERCP is both

diagnostic and may be therapeutic in some cases. It is

performed under anaesthesia or sedation. The

limitations of ERCP are technical, as the eﬃcacy

depends on the expertise of the gastroenterologist.

3,4

addition, sometimes the anatomy of the biliary tract

poses diﬃculty in the safe removal of the biliary stones.

This leads to retained stones or other complications,

which ultimately result in surgical management.

MRCP is a non-invasive means for diagnosing biliary

stones. In addition, it allows visualisation of the biliary

channels for the detection of any anatomical variations

in the biliary tree, thus guiding both the

gastroenterologist performing the ERCP and the

surgeon performing biliary tract surgery for the removal

of stones.

Makmun D et al reported sensitivity,

specificity, accuracy, positive predictive value and

negative predictive value of MRCP as 81%, 40%, 68%,

74%, and 50%, respectively.

In another study,

sensitivity, speciﬁcity, PPV, NPV and accuracy of

MRCP were found to be 94.6%, 93.8%, 97.8%, 85.7%

Assistant Professor, Department of

Radiology, Northwest General Hospital

& Research Center, Peshawar

J Gandhara Med Dent Sci

October - December 2025

and 94.4% respectively.

These ﬁndings suggest that

MRCP is a valuable tool in the diagnosis and

management of biliary stones, with high sensitivity and

accuracy in detecting anatomical variations in the

biliary tree. The results of these studies provide

important information for both gastroenterologists and

surgeons, helping them make informed decisions

regarding the treatment of patients with biliary stones.

Overall, MRCP plays a crucial role in guiding medical

professionals in the successful removal of biliary stones

through both ERCP and surgical procedures.

9,10

Most of

these studies are conducted in the Western population.

Further research is warranted to determine the

diagnostic performance of MRCP in detecting

choledocholithiasis within our local population. Should

MRCP exhibit diagnostic performance equivalent to

ERCP, it could be recommended as the ﬁrst-line

imaging modality for diagnosing choledocholithiasis.

This would be a step forward in facilitating diagnosis

and improving patient care.

METHODOLOGY

A retrospective, descriptive, cross-sectional study was

conducted using data retrieved from the hospital

information management system in the Department of

Radiology at Northwest General Hospital and Research

Centre, Peshawar. After obtaining ethical approval from

the hospital's ethics committee (IRB&EC/2025-

GH/0238), data from October 15, 2022, to October 15,

2024, were retrieved. A total of 224 patients with

suspected choledocholithiasis were included in the

study through non-probability consecutive sampling.

Excluded from the study were patients having

contraindication to either of the diagnostic techniques

(MRCP, ERCP). Informed written consent was taken.

The MRCP images were interpreted by two consultant

radiologists using a standardised reporting template. In

cases where there was disagreement, a third radiologist

was consulted to provide an additional opinion and

resolve the discrepancy. Data, including name, age,

gender, body mass index (Kg/m²), height, weight, and

occupation, were entered into a proforma for analysis.

Each entry was double-checked for accuracy and

completeness. Any missing or incomplete data was

addressed as follows: If the missing data was minimal

or non-critical, the record was included. Patients with

signiﬁcant missing data were excluded from the

analysis if their presence would compromise the study's

integrity. The data was evaluated with SPSS version

25.0. The descriptive analysis was performed, and the

data were presented in the form of frequencies and

percentages.

RESULTS

The study was conducted on 224 patients who presented

with epigastric pain and were referred for MRCP with

suspected choledocholithiasis. The mean age of the

sample was 46.8 + 7.8 years. The minimum age was 30

years, and the maximum age was 60 years. The mean

B MI o f the s a m ple w a s 2 8 . 4 ± 2 .9kg / m².

Table 1: Demographics of the Sample (n=224)

Frequency %age

Age

Group(Year)

30-40 30-40 24.6

40-50 40-50 46.4

50-60 50-60 29.0

Gender

Male 133 59.4

Female 91 40.6

BMI (kg/m

23-25.5 47 21.0

25.5-29.9 89 39.7

29.9-33.5 88 39.3

Table 2: Frequency of Choledocholithiasis on Mrcp (N=224)

Choledocholithiasis on

MRCP

Frequency %age

Yes 147 65.6

No 77 34.4

Table 3: Frequency of Choledocholithiasis on Ercp (n=224)

Choledocholithiasis on

MRCP

Frequency %age

Yes 131 58.5

No 93 41.5

Table 4: Mrcp and Ercp 2 X 2 Table (n = 224)

Choledocholithiasis on

MRCP

Choledocholithiasis on ERCP

Yes 119 28

No 12 65

Sensitivity of MRCP: TP/TP + FN = 90.8% Speciﬁcity

of MRCP: TN/TN + FP = 69.9% Positive Predictive

Value MRCP: TP/TP + FP = 81% Negative Predictive

Value MRCP: TN/TN + FN = 84.4% Accuracy of

MRCP: TP + TN / n = 82.1%

DISCUSSION

Obstructive jaundice is a common clinical problem

diagnosed based on clinical and laboratory ﬁndings, but

to identify the cause of obstruction, diﬀerent imaging

modalities are available.

There are several causes of

obstruction at both intrahepatic and extrahepatic levels.

The most common intraductal cause of obstruction is

calculi; other causes are benign and malignant biliary

strictures, neoplasms like cholangiocarcinoma, parasites

and primary sclerosing cholangitis. Extraductal causes

include compression of biliary channels by

periampullary masses, pancreatitis, pseudo-pancreatic

cysts, and mucoceles.

11,12

Ultrasound is the initial

Diagnostic Accuracy of Magnetic Resonance Cholangiopancreatography

J Gandhara Med Dent Sci

October - December 2025

imaging investigation in patients with obstructive

jaundice. The sensitivity of ultrasound in detecting

choledocholithiasis varies between 20-80%.13 Distal

CBD stones are often missed on ultrasound due to

overlying duodenal gas.

Moreover, the diagnostic

value of ultrasound in biliary stones is inconsistent, as it

depends on the operator’s experience and the patient’s

body habits. The gold standard for examining the

hepatobiliary and pancreatic channels is Endoscopic

retrograde cholangiopancreatography (ERCP).

14,15

This

is widely used for both diagnostic and therapeutic

purposes. ERCP is an invasive technique and thus

carries the risks of biliary infection and other

complications.

It is associated with 1-7%

morbidity.

15,16

Magnetic Resonance

Cholangiopancreatography (MRCP) has high accuracy

in detecting biliary duct calculi. Furthermore, it is a

multiplanar and non-invasive imaging modality with no

ionising radiation.

MRCP is a heavy T2-weighted MR

imaging method that requires no contrast

administration. It has 88.9% sensitivity and 100%

specificity for diagnosing biliary stones. Its positive

predictive value (PPV), negative predictive value

(NPV) and accuracy rates are 100%, 99.2% and 99.2%,

respectively.

Sensitivity, speciﬁcity, PPV, NPV and

diagnostic accuracy of MRCP were recorded as

83.33%, 93.88%, 90.91%, 88.46%, and 89.41%

respectively, taking operation as the gold standard.

The diagnostic attributes of MRCP included 95%

sensitivity, 73.33% speciﬁcity, 93.44% positive

predictive value (PPV), 78.5% negative predictive

value and 90.66% diagnostic accuracy.

The evidence

on patient satisfaction shows that patients prefer MRCP

over diagnostic ERCP. The diagnostic accuracy,

sensitivity and speciﬁcity of MRCP in our study were

comparable to those reported in the literature.

16,17,18

The

purpose of this research was to determine the diagnostic

accuracy of MRCP in the

diagnosis of

choledocholithiasis, using ERCP as the gold standard.

We evaluated diagnostic accuracy based on sensitivity,

specificity, positive predictive value, and negative

predictive value, which were comparable to those in

other studies in the literature. MRCP could thus be

proposed as the examination of choice for bile duct

abnormalities, and ERCP could be reserved for

therapeutic intervention.

LIMITATIONS

It is a single-centre study conducted on an urban

population; therefore, the results might not be

generalised to larger populations. We recommend that

more studies, using larger patient samples and spanning

more extended time periods, are required. There is still

more to be done to assist and guide physicians on the

high diagnostic accuracy of MRCP in patients with

suspected choledocholithiasis, to help them reassure

patients and refer them for imaging. Moreover, eﬀect

modifiers such as diabetes, hypertension, and the

expertise of the performing technician should be

included in further studies to determine their impact on

the accuracy of MRCP.

CONCLUSIONS

MRCP is a valuable diagnostic tool for

choledocholithiasis, oﬀering high sensitivity and

specificity. It may be proposed as the diagnostic

modality of choice since it is multiplanar and non-

invasive with no ionising radiation

and requires no

contrast administration.

CONFLICT OF INTEREST: None

FUNDING SOURCES: None

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Anam Safdar - Concept & Design; Data Acquisition; Data

Analysis/Interpretation; Drafting Manuscript; Critical

Revision; Supervision; Final Approval

Sana Iqbal - Concept & Design; Data Acquisition; Data

Analysis/Interpretation; Drafting Manuscript; Critical

Revision; Supervision; Final Approval

Shandana Khan - Concept & Design; Data Acquisition; Data

Analysis/Interpretation; Drafting Manuscript; Critical

Revision; Supervision; Final Approval

AUTHORS CONTRIBUTION

The authors accept responsibility for all aspects of the work

and will ensure that any concerns regarding the accuracy or

integrity of any part are properly investigated and resolved.

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Diagnostic Accuracy of Magnetic Resonance Cholangiopancreatography