Diagnostic Accuracy of Magnetic Resonance Cholangiopancreatography (MRCP) to Diagnose Biliary Stricture as a Cause of Obstructive Jaundice, Keeping Endoscopic Retrograde Cholangiopancreatography (ERCP) as the Gold Standard

Abstract

Background: Biliary tract disease is an important clinical finding that can cause obstructive jaundice, which can be either benign or malignant. Timely diagnosis is important as biliary strictures will be misdiagnosed, causing inappropriate surgical intervention, hepatic dysfunction, progressive biliary obstruction and eventually cholangitis if the diagnosis is delayed. MRCP is a non-invasive imaging modality of the biliary system and ERCP is an important reference and therapeutic procedure.

Objective: To determine the diagnostic accuracy of magnetic resonance cholangiopancreatography for detecting biliary stricture as a cause of obstructive jaundice, using endoscopic retrograde cholangiopancreatography as the reference standard.

Methods: This cross-sectional validation study was conducted in the Department of Diagnostic Radiology, Combined Military Hospital (CMH), Peshawar and Saidu Group of Teaching Hospital, Swat over a period of three months from June 2026 to September 2026.  Include  a total of 203 patients with obstructive jaundice were included. MRCP was followed by ERCP for all participants. The following parameters were noted: demographic parameters, serum bilirubin, serum alkaline phosphatase, duration of jaundice and the type and presence of biliary stricture. MRCP's diagnostic performance was assessed by calculating the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy based upon the ERCP results.

Results: The mean age of participants was 44.18 ± 10.92 years, and 116 (57.1%) were male. ERCP confirmed biliary stricture in 44 (21.7%) patients, whereas MRCP identified stricture in 70 (34.5%) patients. There were 38 true-positive, 127 true-negative, 32 false-positive, and 6 false-negative findings. MRCP demonstrated a sensitivity of 86.4%, specificity of 79.9%, PPV of 54.3%, NPV of 95.5%, and overall diagnostic accuracy of 81.3%.

Conclusion: MRCP showed good diagnostic performance for detecting biliary strictures in patients with obstructive jaundice, particularly because of its high sensitivity and NPV. Its non-invasive nature makes it useful for initial assessment and for identifying patients in whom invasive evaluation with ERCP may be more selectively employed.