Magnetic Resonance Cholangiography and Intraoperative Cholangiography in Acute Cholecystitis
Magnetic Resonance Cholangiography and Intraoperative Cholangiography in Acute Cholecystitis
The treatment of choice for acute cholecystitis is cholecystectomy performed as soon as
 possible after onset of symptoms. Up to 9-22% of patients undergoing cholecystectomy due to
 cholecystitis have common bile duct stones. Magnetic resonance cholangiopancreatography
 (MRCP) can aid in technical planning of the operation. Intraoperative cholangiography (IOC)
 is another method to assess anatomy and stones during operation. There is a lack of quality
 studies comparing findings of MRCP and IOC and effect on hospital admission.

 The aim of this study is to systematically assess the quality of MRCP and IOC in acute
 cholecystitis, and observe the effect of routine MRCP on surgery outcomes, length of hospital
 stay, hospital admission costs, and evaluate whether routine IOC could be replaced by MRCP.
Background

 The treatment of choice for acute cholecystitis is cholecystectomy performed as soon as
 possible after onset of symptoms. Early cholecystectomy within 4 days after onset of symptoms
 resulted in reduced costs, morbidity and shorter hospital stay than delayed cholecystectomy.

 Preoperative magnetic resonance cholangiopancreatography ( MRCP) is usually performed if
 there is a clinical suspicion of common bile duct ( CBD) stones. CBD stones in acute
 cholecystitis can be found in up to 9-22% of cholecystectomized patients. MRCP in acute
 cholecystitis can aid in technical planning of laparoscopic cholecystectomy. The benefit of
 MRCP is the non-invasiveness of the technique with 85-95% sensitivity and 93%-97%
 specificity.There is a lack of good-quality prospective studies concerning the findings of
 MRCP and intraoperative cholangiography (IOC) in acute cholecystitis. The purpose of
 preoperative diagnosis of CBD stones is to facilitate adequate planning of CBD stone removal,
 which is preferably performed as a single-stage procedure.

 In acute cholecystitis the cystic duct may be obliterated and thus cause cannulation
 difficulties . In these situations preoperative MRCP may give valuable information if CBD
 stones are present.

 The aims of this study is:

 1. To observe the feasibility of routine preoperative MRCP in acute cholecystitis in
 Central Finland Central Hospital

 2. To study and compare the quality of MRCP and IOC in acute cholecystitis

 3. To study the impact of preoperative MRCP findings in surgical outcome of laparosocpic
 cholecystectomy

 All patients with clinically and radiologically proven acute cholecystitis during one year
 (2019) will form the study cohort. Ultrasound and MRCP are performed unless there are no
 contraindications. The quality of MRCP is systematically and independently evaluated by two
 experienced radiologists. Laparoscopic or open cholecystectomy is programmed and IOC is
 performed if feasible. The quality and technical success of IOC is recorded and the c-arm
 cholangiography is documented and stored in the hospital database. In case of common bile
 duct stones the operating surgeon will decide the policy of stone removal.

 The onset of symptoms, hospital arrival, time from arrival to operation, laboratory values,
 operative details, 30 day morbidity and postoperative outcome are evaluated.
Inclusion Criteria:

 • Clinically and radiologically confirmed acute cholecystitis

 Exclusion Criteria:

 -  Contraindication for MRCP

 -  Patients refuses MRCP