Photo Credit: Md Ariful Islam
The following is a summary of “Pilot Feasibility Study to Determine the utility of Direct Access and Quantitative Magnetic Resonance Cholangiopancreatography (MRCP) in the Assessment of Suspected Acute Biliary or Ductal Gallstone Presentations,” published in the February 2025 issue of the BMC Gastroenterology by Novak et al.
This study examines the diagnostic efficiency, clinical outcomes, and cost-effectiveness of direct magnetic resonance cholangiopancreatography (MRCP) compared to the standard diagnostic approach in patients with suspected acute gallstone disease and abnormal liver function tests (LFTs). While abdominal ultrasound is the standard initial imaging modality, MRCP is frequently performed for patients with abnormal LFTs, potentially rendering ultrasound redundant in this subset of patients. However, the high inter-reader variability in MRCP interpretation underscores the need for automated tools to enhance accuracy and standardization. Recent advancements in AI technology may provide a solution by automating the detection and quantification of key MRCP parameters.
This study employed a randomized design in which patients with suspected acute gallstone disease and deranged LFTs were assigned to either a direct MRCP pathway or standard care. Clinical data, healthcare resource utilization, and associated costs were recorded, with cost analysis based on National Health Service (NHS) national 2020/21 tariffs. Additionally, MRCP images were analyzed using MRCP+ software (Perspectum Ltd) to evaluate automated gallbladder and biliary duct measurements. A total of 27 participants were enrolled over a 12-month period, with 15 allocated to the direct MRCP group and 11 to standard care. One patient was excluded from the final analysis. The direct MRCP group demonstrated a reduced mean time to diagnosis (2.53 days) compared to the standard care group (4.18 days). Furthermore, direct MRCP was associated with lower mean per-patient diagnostic costs (£449.54 vs. £742.06) and reduced overall costs per diagnosis (£647 vs. £896) compared to standard care. Automated MRCP+ analysis of 11 scans revealed significant differences between patients with and without gallstones, specifically in gallbladder volume (80.2 mm3 vs. 30.1 mm3, p = 0.018) and cystic duct median width (4.6 mm vs. 2.7 mm, p = 0.042), suggesting that automated quantitative MRCP assessment may facilitate more precise detection of biliary obstruction.
These findings suggest that direct MRCP may serve as a feasible and cost-effective diagnostic strategy for patients presenting with suspected acute gallstone disease and abnormal LFTs, potentially streamlining patient management by reducing diagnostic delays and unnecessary imaging procedures. Additionally, the integration of AI-driven MRCP analysis offers promise in enhancing diagnostic accuracy and standardization. Larger-scale trials are necessary to further validate these findings and establish direct MRCP as a primary diagnostic approach for this patient population.
Source: bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-025-03637-0
