| Low obstructive jaundice is one of the more common symptoms and is usually caused by a malignant tumor, common bile duct stone and infection. With the advances in image diagnostic technique and diagnostic equipment, image diagnosis has a variety of methods, including magnetic resonance cholangiopancreatography (MRCP), percutaneous transhepatic cholangiography (PTC), B Ultra (US), CT, endoscopic retrograde pancreaticobiliary angiography (ERCP) and so on. It is essential for the diagnosis and treatment of obstructive jaundice to select appropriate examination methods and make a reasonable application, that is, to achieve diagnostic purposes and furthest reduce or avoid adverse reactions. In the past, it was believed that ERCP was preferred method to diagnose obstructive jaundice caused by the disease of ampulla and its surrounding part and was the "gold standard" for diagnosis of pancreatic biliary disease. However, ERCP is a technically demanding operation and an invasive examination with 3% to 9% of intubation failure rate, 7% of complications incidence rate and 0.05-0.1% of mortality rate. And ERCP can not reflect the shape of biliary pancreatic duct in the natural state because of the impact of contrast agent pressure; ERCP can not display the whole picture because of complete obstruction in the biliary pancreatic duct; ERCP can not display tumors outside common bile duct and the adjacent tissues and lacks a comprehensive understanding of relationship between the tumor and surrounding tissue, therefore, it is difficult to judge whether the malignant tumors have transferred to the surrounding tissues and lymph nodes. MRCP has recently been an examination method which is widely used in diagnosis of biliary pancreatic duct disease with the non-invasion, no radiation, high security, no contrast agent, repeat examination in a short time and high success rate. And MRCP can be multi-angle, full range, three-dimensional observation of biliary tract morphology and get high-resolution images of pancreatic duct, besides, MRCP can provide the whole image of the biliary duct tree in the physiological state, and show obstructive surrounding parts and the adjacent tissues. In all these aspects, ERCP can not compare with MRCP. In the evaluation of tumor extent, location and extent of obstruction, with or without liver violations and far transferring, MRCP is obviously superior to ERCP.Objective: To comparatively study on the value of Magnetic Resonance Cholangiopancreatography(MRCP) and Endoscopic Retrograde Cholangiopancreatography(ERCP) in Diagnosis of Low Obstructive Jaundice.Methods: The clinical material from 206 cases of low biliary duct obstruction diagnosed in our hospital from May 2008 to April 2010 are retrospectively analyzed, and common bile duct obstruction located in the posterior and wall segment of duodenum are selected for the study, and all patients are examined by ERCP in five days after the MRCP examination with clinical and MRI data integrity. Image features of MRCP and ERCP of 206 cases are retrospectively analyzed and are contrasted with pathologic and follow-up results respectively, then the qualitative diagnosis coincidence is calculated by MRCP, ERCP and a combination of both.Results: Among 206 cases of low biliary duct obstruction, there were 74 cases of low common bile duct stones in which 72 cases were diagnosed by MRCP (97.3%) and 74 cases by ERCP(100%); there were 26 cases of low cholangiocarcinoma in which 24 patients were diagnosed by MRCP (92.3%) and 26 cases by ERCP(100%); there were 96 cases of ampullar and the surrounding carcinoma in which 88 cases were diagnosed by MRCP(91.6%) and 83 cases by ERCP(96.4%); there were 6 cases of benign tumor in pancreatic head in which 6 cases were diagnosed by MRCP(100%) and 5 cases by ERCP(87.5%); there were 4 cases of low inflammatory bile duct stricture in which 3 cases were diagnosed by MRCP (75%) and 4 cases by ERCP (100%). The overall accuracy rate of MRCP and ERCP in diagnosis of low obstructive jaundice is 93.6% and 93.2%, and their difference was not significant (P> 0.05). The accuracy rate of the combination of MRCP and ERCP is 96.1%, and is not significantly different with the accuracy rate of individual MRCP and ERCP (P> 0. 05).Conclusion: MRCP is noninvasive examination method by which the qualitative diagnosis rate of low obstructive jaundice caused by tumor is slightly higher than the diagnosis by ERCP. Especially for the display and diagnosis of tumors outside low common bile duct cavity, MRCP is superior, but the diagnosis of the bile duct stones at the end by MRCP is lower than the diagnosis by ERCP , and ERCP is superior to MRCP in qualitative diagnosis of the primary low bile duct lesions, the intervention treatment of low biliary duct obstruction and biopsy. Currently in diagnosis of low biliary duct obstructive disease, the combination of MRCP and MR can replace ERCP.
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