BANGLADESH JOURNAL OF RADIOLOGY AND IMAGING 2024; VOL.

32(1): 40- 49

Diagnostic Performance of Magnetic Resonance

Cholangiopancreatography (MRCP) in Evaluation
of The Causes of Obstructive Jaundice
SARASWATI BASAK1, MD NOMAN CHOWDHURY2, FARIA AKHAND3, PROSANTA
BARIKDER4, MOST. MANIRA KHATUN5, MASHRUBA SURYYA KHALED6, SAMAPTI
CHAKRABORTY7, MD HASAN JUVAER ROMEL8.

Abstract: carcinoma head of pancreas 09(15%), carcinoma

Background: Jaundice resulting from obstruction of the gallbladder 07(11.6%), biliary ascariasis
of passage of bile from the liver to the duodenum 05(8.3%) and cholangiocarcinoma 03(5%). MRCP
is termed as obstructive jaundice. The expanding findings of benign aetiology was found in 63.3%
spectrum of therapeutic options for patients with cases and rest 36.6% were malignant. ERCP
surgical jaundice makes it necessary for the revealed CBD stone in 46.6%, biliary ascariasis in
radiologist to precisely assess the aetiology, 8.3%, chronic pancreatitis in 5%, carcinoma
location, level and extent of disease. Objectives: gallbladder in 11.6%, pancreatic head carcinoma
To assess the diagnostic performance of MRCP in in 11.6% and periampullary carcinoma in 3.33%
evaluation of the causes of obstructive jaundice. of patients. Histopathology of the malignant
Method: This cross sectional observational study aetiology revealed carcinoma gallbladder in
was performed in Department of Radiology and 07(11.6%) patients, pancreatic head carcinoma in
Imaging, Dhaka Medical College Hospital, Dhaka, 07(11.6%), cholangiocarcinoma in 03 (5%) and
from July 2017 to June 2019. Patients with clinical periampullary carcinoma in 02(3.33%) patients.
& biochemical evidence of obstructive jaundice Comparison of MRCP with ERCP and
were the study subjects. MRCP diagnosis of causes histopathology revealed statistically significant
of obstructive jaundice were compared with ERCP results with a sensitivity, specificity, positive
and histopathology findings. Results: In the study,
predicative value, negative predicative value and
the maximum number of patients 26(43.3%) were
accuracy of MRCP as 87.8%, 89.4%, 94.7%, 77.2%
in the age group 46-60 years and the mean age
and 88.3 % respectively. Conclusions: MRCP is a
was 48.6 ± 7.52 years. Out of 60 cases, 37(62%)
very good modality for aetiological evaluation of
were female and 23(53%) were male with a female
the patients with obstructive jaundice.
to male ratio of 1.6:1. MRCP findings revealed that,
calculus in CBD 27(45%) was the commonest Key words: MRCP, Obstructive Jaundice.
detected cause of obstruction, followed by
Introduction:
Jaundice resulting from obstruction of passage of
Author of correspondence: Dr. Saraswati bile from the liver to the duodenum is termed as
Basak, MBBS, MD. Assistant Surgeon, obstructive jaundice. Any blockage in the
Department of Radiology and Imaging, Sheikh hepatobiliary system pathway leads to lack of
Hasina National Institute of Burn & Plastic passage of bile into the intestine. Passage of this
Surgery (SHNIBPS), Dhaka. Mobile: +8801717-
bile into the circulation leads to symptoms like
184354. Email: [email protected]
jaundice and pruritus.1

1) Radiologist, Department of Radiology and Imaging, Sheikh Hasina National Institute of Burn & Plastic Surgery
(SHNIBPS), Dhaka. 2) Professor & Ex-HOD, Department of Radiology & Imaging, DMCH, Dhaka. 3) Radiologist,
Kuwait-Bangladesh Friendship Government Hospital, Uttara, Dhaka. 4) Medical officer, Sheikh Russel National
gastroliver Institute and hospital, Dhaka. 5) Assistant Professor, Department of Radiology and Imaging, Mugda
Medical College, Dhaka. 6) Specialist, Department of Radiology and Imaging, Asgar Ali Hospital, Dhaka. 7)
Radiologist, Mugda Medical College and Hospital, Dhaka & 8) Medical officer, Department of Radiology and
Imaging, Dhaka Medical College and Hospital, Dhaka.
Received: 09 August 2023 Revised: 10 October 2023 Accepted: 18 October 2023 Published: 01 Jan 2024

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Diagnostic Performance of Magnetic Resonance Cholangiopancreatography (MRCP) Saraswati Basak et al

Obstructive Jaundice has been mainly diagnosed pancreatic ducts. MRCP may offer greater safety,
by imaging modalities. The main goals of any less discomfort, greater patient acceptance and can
imaging procedure in obstructive jaundice are to also be used whenever ERCP is impossible because
confirm the presence of obstruction, its location, of anatomical or technical reasons. In this clinical
extent, probable cause, and it should also attempt application, MRCP has proved to be as sensitive
to obtain a map of biliary tree that will help the and specific as diagnostic ERCP. Currently, the
surgeon the determine the best approach to each diagnostic accuracy of MRCP is considered to be
individual case. Among all imaging technique equivalent to that of ERCP for a broad spectrum
Ultrasonography (USG) and Computed of benign and malignant pancreatic and biliary
Tomography (CT) are initial modalities of duct diseases.7
investigations. Recently, Magnetic Resonance
Therefore, aim of this study was to assess the
Imaging (MRI) with Magnetic Resonance
diagnostic performance of MRCP in the evaluation
Cholangiopancreatography (MRCP) is emerging
of the causes of obstructive jaundice.
as an exciting tool for non-invasive evaluation of
patients with obstructive jaundice.2 Material and Methods:
It was a cross sectional type of observational study
In investigating obstructive jaundice, USG gives
conducted in Department of Radiology & Imaging,
clues for further investigations including CT scan,
Dhaka Medical College Hospital (DMCH) from
MRCP, Endoscopic Retrograde Cholangio-
July 2017 to June 2019 for a period of 2 years.
pancreatography (ERCP) and Percutaneous
The study subjects were patients with clinical &
Cholangiography (PTC).3 But the disadvantage of
biochemical evidence of obstructive jaundice,
USG is that the procedure is highly operator referred to Radiology & Imaging department of
dependent and is also influenced by patient factors DMCH either from out or in patient departments
such as the number, size and site of calculi, of Gastroenterology & Surgery, DMCH for
patient’s body habitus and the presence of imaging investigation. A total number of 60
overlying bowel gas. 4 PTC is also operator patients were included in this study. Nonrandom
dependent and is associated with relatively high purposive sampling was done for patients of all
rate of complications.5 ages & both sexes with clinical symptoms like
yellow coloration of skin & sclera, dark urine, clay
ERCP is the reference standard in diagnosis of stool, pruritus, anorexia, weight loss, fever,
biliary tract disease, allowing for definite or abdominal pain, feeling of mass & having raised
temporary treatment in many cases. ERCP biochemical parameters (serum bilirubin, serum
presents some draw backs: selective main bile duct ALT & serum ALP) of obstructive jaundice.
cannulation (80-90%), operator dependence and Patients with contraindications to the MRCP
lowered rates in certain conditions as distal technique (i.e. patients with cardiac pacemaker,
cerebral aneurysm clip, ocular/cochlear implants,
strictures, sphincter of Oddi stricture, tumor of
metal prostheses, claustrophobia) were excluded.
papilla and duodenal diverticula.6
All the patients were evaluated by MRCP and
MRCP is the newest modality for biliary and findings were subsequently compared with ERCP
pancreatic duct imaging. It uses MR imaging to and histopathology findings. After collection,
visualize fluid in the biliary and pancreatic ducts editing and coding, the coded data was entered
as high signal intensity on heavily T2 weighted into the computer by using SPSS version 22.
(T2W) sequences of Half Fourier Single Shot Turbo Ethical clearance was obtained from the authority
Spin Echo (HASTE). It can demonstrate the entire of DMCH to undertake the present study.
anatomy of the biliary tract and so it helps to Informed written consent was obtained from each
delineate biliary tract in proximal and in distal subject who voluntarily provided consent to
obstruction.1 participate in the study.

With the development of fast imaging sequences, Diagnostic procedures:

MRCP has become an exciting new imaging MRCP: Patients were fasted for 4-6 hours prior
technique. ERCP still offers the highest sensitivity to the study in order to reduce fluid secretions
and specificity for the evaluation of biliary and within the stomach and duodenum, reduce bowel

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Bangladesh Journal of Radiology and Imaging Vol. 32(1): January 2024

peristalsis and promote gallbladder distension. At branches, signal void areas in MPD are the other
our institution, MRCP was performed by criterion of MRCP.11
HITACHI ECHELON OVAL, 1.5 Tesla machine
Periampullary carcinoma: MRCP criterion are
using a phased-array body coil. At first an axial
“Double-duct sign” of dilated CBD and pancreatic
heavily T2 weighted 2D breath-hold HASTE
ducts with or without bulging mass protruding into
sequence was taken. Two breath-hold acquisitions
distal CBD. ERCP criterion are dilated CBD and
were also obtained, so that the whole of the liver
pancreatic duct with or without visible ampullary
down to the duodenal ampulla is visualized.
mass.10
Following this, two 3D respiratory-triggered
heavily T2-weighted FSE sequences in the coronal Carcinoma gallbladder (Resendea et al):
oblique plane was performed. The imaging plane Magnetic resonance cholangiopancreatography
is selected from the initial axial T2-weighted (MRCP) criterion are hyperdense structure within
images, with one acquisition aligned to the the gallbladder infundibulum, bile duct dilatation
common bile duct (CBD) in the head of the and filling defect and pancreaticobiliary
pancreas and the second acquisition aligned to the maljunction. ERCP criterion is frond-like mass
pancreatic duct. Respiratory triggering is achieved within the gallbladder.12
with the use of a navigator sequence. A stack of Cholangiocarcinoma: MRCP criterion are
40 slices are obtained, which are contiguous and irregular narrowing of the bile ducts, with or
each of 1.5 mm in thickness. As the images are without obstruction, asymmetric narrowing of the
heavily T2-weighted, the pancreaticobiliary tree lumen, abrupt narrowing of the lumen and
is displayed as high signal intensity, whilst intraluminal filling defect. ERCP criterion for
adjacent structures are of reduced signal intensity. cholangiocarcinoma are filling defect or area of
narrowing, with irregular borders at the level of
Diagnostic criterion:
occlusion.13
Biliary strictures: As per Singh et al.8 & Surg
et al.9 MRCP & ERCP criterion taken was focal Biliary ascariasis: MRCP criterion is linear
change in luminal caliber with proximal hypointense signal of worm or hypointense tubular
extrahepatic duct dilatation. filling defect in CBD. Endoscopic retrograde
cholangiopancreatography criterion is a cylindrical
Calculus in CBD: MRCP criterion of low-signal
filling defect on the dilated common bile duct.14
filling defect within CBD surrounded by high-
signal bile. ERCP criterion is filling defects within Results:
the opacified CBD.10 The result and observations of the study is given
Choledochal cysts: As per Horn10 and Griffin et below.
al.11 Multiple cystic dilatations of the bile ducts
with both intra and extra hepatic components are
Table-I
taken as MRCP criterion. In ERCP contrast
Age distribution of the patients (n=60).
material seen filling cystic dilatations.
Carcinoma head of pancreas: MRCP criterion Age Number of patients with Sex Total
taken was the classical ‘double duct’ sign in a (years) Male Female
(n= 23) (n= 37)
patient with carcinoma at the head of pancreas
n (%) n (%) n (%)
with dilatation of both the CBD and pancreatic
duct and distension of the gallbladder.11 15-30 01 (4.35%) 03 (8.11%) 04 (6.7%)
31-45 08 (34.78%) 12 (32.43%) 20 (33.3%)
Chronic pancreatitis: Chronic pancreatitis was
considered by MRCP when there was dilatation 46-60 11 (47.83%) 15 (40.54%) 26 (43.3%)
of the main pancreatic duct, ectasia of the side 60-65 03 (13.04%) 07 (18.92%) 10 (16.7%)
branches and a low signal filling defect in the Total 23 37 60
proximal pancreatic duct. Long symmetric &
Mean ± SD 45.9±11.4
smooth stricture in distal common bile duct,
dilatation of main pancreatic duct and its SD=Standard deviation

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Diagnostic Performance of Magnetic Resonance Cholangiopancreatography (MRCP) Saraswati Basak et al

Table I shows the maximum number of patients Table- IV

26(43.3%) were in the age group 46-60 years, Shows MRCP diagnosis of causes of obstructive
followed by 20(33.3%) of patients in the age group jaundice (n=60).
31-45 years. Table also shows that as per gender Causes of obstruction Number of Percentage
distribution 37(62%) were female and 23(53%) patients (n) (%)
were male with a female to male ratio of 1.6:1. Choledochal cyst 02 3.33
Bile duct stricture 01 1.66
Calculus in CBD 27 45
Table-II Chronic pancreatitis 03 05
Shows the clinical presentation of the patients Carcinoma gallbladder 07 11.6
(n=60). Cholangiocarcinoma 03 05
Pancreatic head carcinoma 09 15
Clinical features Number of Percentage Periampullary carcinoma 03 05
patients (n) (%) Biliary ascariasis 05 8.3
Jaundice 60 100 Table IV showing the causes of obstructive
Darkening of urine 60 100 jaundice, diagnosed by MRCP. Most number of
cases (45% of the total) were diagnosed as calculus
Clay coloured stools 55 91.66 in CBD. Nature of obstructive jaundice due to
Pruritis 43 71.6 benign and malignant aetiology were 63.3% (38/
60) and 36.6%(22/60) respectively.
Nausea, vomiting 49 81.7
Table- V
Anorexia & weight loss 38 63.3
Shows ERCP diagnosis of causes of obstructive
Abdominal pain 60 100 jaundice
Scratch marks 39 65 Causes of Number of Percentage
Fever 32 53.3 obstruction by ERCP patients (n) (%)
Choledochal cyst 03 5%
Abdominal mass 20 33.3
Bile duct stricture 02 3.33%
Calculus in CBD 28 46.6%
Chronic pancreatitis 03 5%
Table II shows that jaundice, dark coloured urine
Biliary ascariasis 05 8.3%
and pain in the right hypochondriac region of
abdomen was present in all patients followed by Table V shows the maximum etiology of
clay coloured stool in 92% of the patients. obstructive jaundice diagnosed by ERCP revealed
CBD stone in 28(46.6%).
Table-III
Shows the distribution of the patients by liver Table- VI
function test (n=60) Shows histopathological diagnosis of causes of
obstructive jaundice.
Liver Function Male Female P Histopathological Number of Percentage
Tests Mean+SD Mean+SD value Diagnosis patients(n) (%)
Serum Bilirubin 4.11 ±1.7 5.25±1.8 0.876ns Carcinoma gallbladder 07 11.6
(mg/dl) Cholangiocarcinoma 03 05

ALT (U/L) 125.8±33.2 153.2±68.8 0.865ns Pancreatic head carcinoma 07 11.6

Periampullary carcinoma 02 3.33
ALP(U/L) 608.22 ±137.5 642.4±232.8 0.526ns
Table VI shows the causes of obstructive jaundice
based on histopathological findings. The results
Table III shows the liver function test of the revealed carcinoma gallbladder in 07(11.6%),
patients. p value reached from unpaired t-test and pancreatic head carcinoma in 07(11.6%),
level of significance was considered p<0.05. cholangiocarcinoma in 03 (5%) and periampullary
s=significant; ns=not significant. carcinoma in 02(3.33%) patients.

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Bangladesh Journal of Radiology and Imaging Vol. 32(1): January 2024

Table-VII
Shows comparison of MRCP diagnosis with final diagnosis (Done with ERCP and histopathology,
n=60)

Causes of Obstructive Jaundice MRCP diagnosis TP FP FN Final diagnosis

Choledochal cyst 02 02 0 1 03
Bile duct stricture 01 01 0 1 02
Calculus in CBD 27 26 1 2 28
Chronic pancreatitis 03 02 1 1 03
Carcinoma gallbladder 07 07 0 0 07
Cholangiocarcinoma 03 03 0 0 03
Pancreatic head carcinoma 09 07 2 0 07
Periampullary carcinoma 03 01 2 1 02
Biliary ascariasis 05 05 0 0 05
TP=True positive, FP=False positive, FN= False negative.

Table VII shows, among 28 finally diagnosed cases Table-VIII shows that in this study, MRCP
of calculus in CBD, 27 was diagnosed by MRCP, diagnosed carcinoma gallbladder with 100%
where 26 cases were true positive and 01(one) case sensitivity, specificity, PPV & NPV. In case of
was false positive. Among 07 cases of pancreatic pancreatic head carcinoma MRCP showed 100%
head carcinoma all were correctly picked up by sensitivity, 96.2% specificity, 77.8% PPV & 100%
MRCP findings with 02 false positive cases. 07 NPV. Cholangiocarcinoma was found in 5% of
cases of carcinoma gall bladder, 05 cases of biliary cases with 100% sensitivity, specificity, PPV &
ascariasis, 03 cases of chronic pancreatitis, 03 NPV. Chronic pancreatitis was seen in 3 cases with
cases of cholangiocarcinoma and 02 cases of 66.7% sensitivity, 98.2% specificity, 66.7% PPV
periampullary carcinoma were also perfectly and 98.2% NPV. Periampullary carcinoma was
diagnosed by MRCP. Among 03 choledochal cyst seen in 3 cases with 50% sensitivity, 96.5%
cases, 02 were consistent with MRCP findings and specificity, 33.3% PPV & 98.2% NPV. Biliary
MRCP diagnosed a bile duct stricture case out of ascariasis was seen in 5 cases with 100%
02 cases. sensitivity, specificity, PPV & NPV.

Table-VIII
Validity of MRCP in evaluation of the causes of obstructive jaundice (n=60).

Causes of Obstructive MRCP Final FP FN Sensitivity Specificity PPV NPV

jaundice diagnosis diagnosis (%) (%) (%) (%)
Choledochal cyst 02 03 0 1 66.7 100 100 98.2
Bile duct stricture 01 02 0 1 50 100 100 98.3
Calculus in CBD 27 28 1 2 92.8 96.8 96.2 93.9
Chronic pancreatitis 03 03 1 1 66.7 98.2 66.7 98.2
Ca-gallbladder 07 07 0 0 100 100 100 100
Cholangio carcinoma 03 03 0 0 100 100 100 100
Pancreatic head Ca 09 07 2 0 100 96.2 77.8 100
Periampullary Ca 03 02 2 1 50 96.5 33.3 98.2
Biliary ascariasis 05 05 0 0 100 100 100 100

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Diagnostic Performance of Magnetic Resonance Cholangiopancreatography (MRCP) Saraswati Basak et al

Table-IX
Comparison of MRCP findings with ERCP diagnosis (n=60)
MRCP findings ERCP Diagnosis c2 df P value
Benign (n=41) Malignant (n=19)
Benign (n=38) 36 02 60.07 1 <0.0001
Malignant (n=22) 05 17 12.7 1

Table-X
Comparison of MRCP findings with Histopathology diagnosis (n=24)
MRCP findings Histopathology Diagnosis c2 df P value
Benign (n=05) Malignant (n=19)
Benign (n=02) 04 18 29.6 1 <0.0001
Malignant (n=22) 01 01 3.24 1

Table-IX shows the correlation of MRCP findings also elaborates that 18 cases were true positive
and ERCP diagnosis. Among 38 MRCP diagnosed (TP), 01 was true negative (TN), 04 cases were false
cases of benign obstructive jaundice, 36 were found positive (FP) and 01 false negative (FN) cases.
benign by ERCP findings. On the other hand,
100
amongst 22 cases of MRCP diagnosed obstructive
90
jaundice cases of malignant origin, 17 were
80
confirmed with ERCP. The result was statistically
70
significant. Table also elaborates that 36 cases 60
were true positive (TP), 17 were true negative
50
(TN), 02 were false positive (FP) and 05 false
40
negative (FN) cases.
30
Table X shows the correlation of MRCP findings 20
and histopathological diagnosis. Among 22 MRCP 10
diagnosed cases of malignant obstructive jaundice, 0
Sensitivity Specificity PPV NPV Accuracy
18 were proven correct histopathologically. Of the
two MRCP diagnosed benign lesions, one was found Fig -1: Showing sensitivity, specificity, PPV, NPV
malignant by histopathology. Finally, in 19 cases and accuracy of the MRCP (n=60) in the evaluation
of obstructive jaundice the cause was of malignant of causes of obstructive jaundice which are 87.8%,
origin. The result was statistically significant. Table 89.4%, 94.7%, 77.2% and 88.3% respectively.

Fig-2: MRCP (Axial section) of source image & Fig-3: MRCP (MIP reformat) showing a signal void
structure in mid part of CBD with proximal biliary dilatation - Choledocholithiasis.

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Bangladesh Journal of Radiology and Imaging Vol. 32(1): January 2024

Fig-4: Coronal section & Fig-5: Axial section of source image of MRCP showing a signal void structure
in distal part of CBD with upstream biliary dilatation - Choledocholithiasis.

Fig-6: ERCP shows a round, radiolucent filling Fig-7: Coronal section of source image of MRCP
defect with dilated CBD, CHD and intrahepatic showing soft tissue signal intensity area in mid
biliary tree - Choledocholithiasis and distal part of CBD with upstream biliary
dilatation -Growth in mid and distal CBD.

Fig-8: MIP reformat of MRCP Fig-9: Axial section & Fig- 10: Coronal section of source image of
image shows moderate dilatation MRCP showing soft tissue signal intensity area in neck of Gall
of intrahepatic biliary tree, LHD,
bladder with adjacent hepatic and porta-hepatis invasion
RHD, CHD & proximal CBD
with non-visualization of distal
and part of mid CBD in above
mentioned case.

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Diagnostic Performance of Magnetic Resonance Cholangiopancreatography (MRCP) Saraswati Basak et al

Discussion: periampullary carcinoma. One study showed that

In our study, the maximum number of patients, the causes of obstructive jaundice included gall
26(43.3%) were in the age group 46-60 years, stones in 40% patients, mass in head of pancreas
followed by 20(33.3%) of patients in the age group in 32% cases, and biliary strictures in 8% cases
31-45 years. Mean age of the patient was 48.6 ± while hepatic abscesses, pseudo-pancreatic cyst,
7.52 years. Out of 60 cases, 37(62%) cases were cholangiocarcinoma, choledochal cyst and
female and 23(53%) were male. Female to male periampullary carcinoma each accounted for 4%
ratio was 1.6:1. A study conducted on 50 patients of cases.3 In another study it was shown that
of obstructive jaundice showed that half of the obstructive jaundice is mainly caused by masses
patients were male and rest half females, with a such as (Carcinoma head of pancreas) which
male to female ratio of 1:1. The age of the patients represented 51% and the rest by stone
ranged from 46 to 93 years.3 Another study showed representing 19%. The study revealed that the
that the incidence of jaundice were more in female incidence of mass of the head of pancreas increased
than the male (58% female and 42% of male), with advanced age due to decrease of immune
because of use of oral contraceptives which lead system and catching of inflammatory diseases.15
to gallbladder stone and also recurrent pregnancy Study results by Saddique & Iqbal showed that
decrease immunity of female which make them 13 (54.17%) patients had jaundice due to
prone to repeated infection.15 Saddique & Iqbal malignancy, 09 (37.5%) had stones in the common
showed in a study of jaundiced patients that their bile duct (CBD) and the remaining 02 (8.33%)
age ranged from 25-65 years (mean age being 41.12 patients had amoebic liver abscesses. In the 13
years); of which 10 were males and 12 females.16 patients of malignant group 05 patients had
Our results are more or less similar to these study Carcinoma head of the Pancreas, 03 had
results. Cholangiocarcinoma, 03 had Carcinoma Gall
Our present study shows that jaundice, right bladder and 02 patients with malignant nodes at
hypochondriac abdominal pain, dark coloured the porta hepatis.16 In a ultrasound based study,
urine and clay colored stool were the commonest the commonest benign causes of obstructive
presentations (100%, 100%, 100% and 92% jaundice were choledocholithiasis (63%), CBD
respectively) of the patients. Other manifestations stricture (12.3%), cholangitis (8%) and pancreatitis
were pruritus, anorexia, weight loss and (6.85%) whereas cholangiocarcinoma (6.85%) and
abdominal mass. A study showed that all the carcinoma head of pancreas (4%) comprised of
patients had jaundice, while abdominal pain, the malignant causes. 5 On broad etiological
pruritis and abdominal mass were other classification our study result of ERCP and
presenting complaints.3 Another study showed histopathological findings showed that, maximum
that 28.2% of patient had painless jaundice 41(68.3%) of obstructive jaundice occurred due to
because most of these patients had been affected benign etiology. Neoplastic etiology was in
with Carcinoma head of pancreas.15 19(31.7%) of patients. Findings are consistent with
In our study it was seen that calculus in CBD result of other study. Tumors causing biliary
(45%), pancreatic head carcinoma (15%), channel obstruction are generally ampullary
carcinoma of gall bladder (11.6%), biliary carcinomas, gall bladder carcinomas extending
ascariasis (8.3%), chronic pancreatitis (05%), into the CBD, metastatic tumors (usually from the
cholangiocarcinoma (05%), periampullary gastrointestinal tract or the breast), secondary
carcinoma (05%), choledochal cyst (3.33%) and bile lymphadenopathies at the porta-hepatis and
duct stricture (1.66%) were the findings on the cholangiocarcinoma. 17 In a study neoplastic
basis of MRCP findings. Among these obstructions were mainly caused by pancreatic
choledocholithiasis, choledochal cyst, biliary tumors; the remaining being cholangiocarcinoma
ascariasis, bile duct stricture and chronic and the lymphadenopathies causing extrinsic
pancreatitis are benign causes. Malignant causes pressure on the CBD. Biliary related malignancies
included carcinoma head of the pancreas,
occur equally in both sexes.18 All the above study
carcinoma of GB, cholangiocarcinoma and
results are almost similar to our study.

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Bangladesh Journal of Radiology and Imaging Vol. 32(1): January 2024

Our results of ERCP revealed CBD stone in results were in good harmony with Endoscopic
28(46.6%) cases, biliary ascariasis in 05(8.3%), retrograde cholangiopancreatography (ERCP) and
chronic pancreatitis in 03(5%), carcinoma histopathological findings.
gallbladder in 07(11.6%), pancreatic head
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