Role of magnetic resonance cholangiopancreatography in choledocholithiasis

In this very interesting study, the authors compared the diagnostic accuracy of ultrasonography (US) with magnetic resonance cholangiopancreatography (MRCP) for the evaluation of choledocholithiasis. The authors retrospectively selected 243 patients suspected for choledocholithiasis who underwent both US and MRCP within 1 month, then they compared common bile duct measurements, false positive and false negative percentages in common bile duct stone detection. The authors concluded that US is ideal as the first step in the diagnostic algorithm for choledocholithiasis. Diagnostic accuracy was high, in line with previously published paper (AUC = 0.727; 95% CI, 0.603–0.852). However, due to the high percentage of false negatives (16%), if patients have elevated liver enzymes or a high risk of CBD stones, MRCP is recommended. This paper underlines the role of US as first step in patients with suspected biliary stones, strengthen its importance in this clinical scenario. On the other hand, the role of MRCP deserves a more comprehensive evaluation