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PubMed2005

[Pancreatic carcinoma--symptoms and diagnostic procedure].

Pancreatic carcinoma is characterized by painful symptoms and an extraordinary unfavourable prognosis. To offer the patient a therapy adjusted to the individual situation the diagnostic work-up has to clear several questions. It is essential to have reliable proof of the diagnosis itself, as well as the stage of the disease. In addition, one should be able to locate the origin of complaints. The diagnostic power of the available invasive and non-invasive techniques increased in recent years. The quality of the diagnostic means depends to a great amount on the experience of the investigator. The most important goal of the diagnostic procedure is to identify metastatic or locally advanced disease without laparotomy. In this case palliative therapy canbe initiated immediately. When the findings are not conclusive, only diagnostic laparotomy can definitely show ifthere is a chance for curative resection.

Adenocarcinoma↗
PubMed2003

Predictive, pre-natal and diagnostic genetic testing for Huntington's disease: the experience in Canada from 1987 to 2000.

Predictive and pre-natal testing for Huntington's Disease (HD) has been available since 1987. Initially this was offered by linkage analysis, which was surpassed by the advent of the direct mutation test for HD in 1993. Direct mutation analysis provided an accurate test that not only enhanced predictive and pre-natal testing, but also permitted the diagnostic testing of symptomatic individuals. The objective of this study was to investigate the uptake, utilization, and outcome of predictive, pre-natal and diagnostic testing in Canada from 1987 to April 1, 2000. A retrospective design was used; all Canadian medical genetics centres and their affiliated laboratories offering genetic testing for HD were invited to participate. A total of 15 of 22 centres (68.2%), currently offering or ever having offered genetic testing for HD, responded, providing data on test results, demographics, and clinical history. A total of 1061 predictive tests, 15 pre-natal tests, and 626 diagnostic tests were performed. The uptake for predictive testing was approximately 18% of the estimated at-risk Canadian population, ranging from 12.5% in the Maritimes to 20.7% in British Columbia. There appears to have been a decline in the rate of testing in recent years. Of the predictive tests, 45.0% of individuals were found to have an increased risk, and a preponderance of females (60.2%) sought testing. A greater proportion of those at < or = 25% risk sought predictive testing once direct CAG mutation analysis had become available (10.9% after mutation analysis vs 4.7% before mutation analysis, p = 0.0077). Very few pre-natal tests were requested. Of the 15 pre-natal tests, 12 had an increased risk, resulting in termination of pregnancy in all but one. Diagnostic testing identified 68.5% of individuals to be positive by mutation analysis, while 31.5% of those with HD-like symptoms were not found to have the HD mutation. The positive diagnostic tests included 24.5% of individuals with no known prior family history of HD.

Adolescent↗
PubMed2000

Effect of diagnostic threshold on the validity and reliability of epidemiological caries diagnosis using the Dundee Selectable Threshold Method for caries diagnosis (DSTM).

OBJECTIVES: To develop a method for recording dental caries at the D1 (enamel and dentine) diagnostic threshold (without loss of D3 information) and assess its reliability, 'benchmark' validity and potential effects on reported caries prevalence and needs assessment. METHODS: Multi-examiner training, calibration and validation trial. Two groups of 10 dental examiners were trained to diagnose dental caries at the D1 (enamel and dentine) diagnostic threshold under the conditions of a caries prevalence survey, prior to a calibration trial being undertaken. RESULTS: Where 'experienced examiners' were trained to examine at the D1 (enamel and dentine) diagnostic threshold, under the conditions of a cross-sectional epidemiological survey, there was no significant deterioration in inter-examiner agreement on the assessment of teeth and a significant difference in one of two comparisons on the assessment of surfaces using the kappa statistic. Assessed against a benchmark examiner, there was no significant loss of sensitivity at the D1 diagnostic threshold compared with the D3 threshold and, although there was a significant loss of specificity at the D1 threshold, all specificity values could be considered to be high. CONCLUSIONS: Modifying the diagnostic criteria typically used in surveys of caries prevalence (to allow assessment of the levels of enamel caries which could benefit from preventive care as well as dentinal caries requiring restorative care) in adolescents does not adversely affect the reliability or benchmark validity of experienced examiners to a significant degree.

Adolescent↗
PubMed2003

Lack of clinicopathologic correlation in the diagnosis of oral lichen planus based on the presently available diagnostic criteria and suggestions for modifications.

INTRODUCTION: Confirmation of a clinical diagnosis of oral lichen planus (OLP) by means of histopathologic study of a biopsy specimen is generally advised. However, hardly any data exist about the correlation between clinical and histopathologic diagnoses of OLP. The aim of the present investigation was to study the correlation between the clinical and histopathologic assessment of OLP, and to propose diagnostic refinements, if appropriate. METHODS: Clinical and histopathologic data of two previously published studies were used for this purpose. The number of clinical cases in which all clinicians agreed as well as the number of microscopic slides on which all reviewing pathologists agreed were calculated and compared with each other in order to assess the clinicopathologic correlation. RESULTS: In 42% of the cases in which all clinicians agreed about the clinical diagnosis being diagnostic of OLP, there appeared to be no consensus on the histopathologic diagnosis. Conversely, in 50% of the cases in which all pathologists agreed about the histopathologic diagnosis being diagnostic of OLP there was a lack of consensus on the clinical diagnosis. CONCLUSION: Based on the findings of the present study, there appears to be a lack of clinicopathologic correlation in the diagnostic assessment of OLP. We therefore propose a set of revised diagnostic criteria of OLP and oral lichenoid lesions, based on the WHO definition of OLP, including clinical as well as histopathologic aspects.

Biopsy↗
PubMed2002

The gold standard for photographing pigmented skin lesions for diagnostic purposes: contact versus distant imaging.

BACKGROUND: It is mandatory that a new diagnostic method be validated by comparison with a well-established reference procedure before being introduced for use in clinical practice. In the field of pigmented skin lesions (PSL), clinical examination should be considered the reference procedure for new diagnostic methods, such as dermoscopy. However, it has not yet been established which is the best photographic procedure for obtaining the most informative clinical images to be used in a formal diagnostic setting. METHODS: In this study we investigated the diagnostic information provided by the two most popular methods currently used for clinical photographing of PSL: "contact" images obtained with a Dermaphot (Heine Ltd) at original x 10 magnification without oil application and "distant" images obtained with a macro objective from a distance of 10 cm. RESULTS: Two experienced dermatologists observed clinical images of a series of 57 PSL (11 melanomas, 31 melanocytic nevi, 10 pigmented basal cell carcinomas, and four other diagnoses). The degree of concordance between the diagnoses based on "contact" and "distant" images (melanoma/non-melanoma) was very good (k = 0.819). Regarding histology, the degree of concordance was better when the diagnosis was based on "contact" images (k = 0.54) than "distant" images (k = 0.47). In particular, "contact" images were superior to "distant" images for diagnosis of non-melanoma lesions (specificity of melanoma diagnosis 87.7% vs. 83.6%), but we found no difference in melanoma detection (73% of sensitivity for both methods). CONCLUSIONS: Although the two photographic procedures appear to provide similar levels of diagnostic information, the "contact" method seems to provide a higher specificity for melanoma diagnosis.

Basal Cell Carcinoma↗
PubMed1991

Some psychometric characteristics of gender diagnosticity measures: reliability, validity, consistency across domains, and relationship to the big five.

Preferences for various occupations, school subjects, everyday activities, and hobbies and amusements were rated by 119 male and 145 female Ss. Discriminant analyses were conducted to compute gender diagnostic probabilities. Ss also rated themselves on Big Five traits and completed the Bem Sex-Role Inventory (BSRI) and the Personal Attributes Questionnaire (PAQ). Results indicated that (a) gender diagnosticity measures showed high reliability, (b) gender diagnosticity predicted sex of S and self-ascribed masculinity (M) and femininity (F) better than contrasted-groups M-F scales, (c) gender diagnosticity measures displayed substantial consistency across domains both within and across the sexes, and (d) gender diagnosticity measures were independent of the Big Five and PAQ and BSRI scales both within and across the sexes, whereas PAQ and BSRI scales loaded highly on Big Five dimensions.

Activities of Daily Living↗
PubMed2001

When do individuals help close others improve? The role of information diagnosticity.

On the basis of the self-evaluation maintenance model (SEM; Tesser, 1988), it was hypothesized that individuals give less improving information to relationally close (rather than distant) others, out of concern for being outperformed by close others in the future. Further, this effect only occurs if diagnostic and valid criteria for success are present. Three studies confirmed the hypotheses. In Studies 1 and 2, participants gave less improving information to familiar than to unfamiliar others in a domain (academics) in which diagnostic assessment criteria (grades) were available. This pattern was not found in a domain (social life) without diagnostic criteria. These results were replicated in Study 3, in which relative performance and diagnosticity of assessment criteria were manipulated and amount of improving information given to friends and strangers was measured. Diagnosticity of comparison information is an important addition to the SEM model.

Adult↗
PubMed2005

BMI, waist-circumference and waist-hip-ratio as diagnostic tests for fatness in adolescents.

OBJECTIVE: To evaluate the diagnostic accuracy of body mass index (BMI, kg/m(2)), waist-circumference (WC) and waist-hip-ratio (WHR) as diagnostic tests for detecting fatness in adolescents. DESIGN: A cross-sectional analysis of 474 healthy adolescents aged 17 y was used. Measurements of height, weight, WC, hip-circumference and body fat percentage (%BF) were obtained. The diagnostic accuracy for detecting excess fatness was evaluated through receiver operating characteristics (ROC) analyses with %BF, measured by densitometry (air-displacement plethysmography), as reference test. RESULTS: BMI and WC showed strong positive correlation (r=0.68-0.73; P<0.0001) with %BF in both sexes, but the correlation was weaker for WHR (r=0.30-0.41; P<0.0001). For overweight and obesity in boys and obesity in girls, the area under the ROC curve was high (0.96-0.99) for BMI and WC. WHR was not significantly better than chance as diagnostic test for obesity in girls. For BMI and WC, highly sensitive and specific cutoffs for obesity could be derived, while larger trade-offs were needed for detecting overweight in girls. The cutoffs producing equal sensitivity and specificity were lower than the ones minimizing the absolute number of misclassifications. The latter approached internationally recommended reference values, but were still several units lower for BMI in girls and several centimeters lower for WC in boys. CONCLUSION: BMI and WC were found to perform well as diagnostic tests for fatness, while WHR was less useful. The discrepancies between cutoffs producing equal sensitivity and specificity, cutoffs minimizing the absolute number of misclassifications and internationally recommended reference values for overweight and obesity highlight the importance of specifying the characteristics of classification systems for different settings.

Adipose Tissue↗
PubMed1998

Choosing a diagnostic cut-off for cannabis dependence.

AIM: While cannabis dependence has been increasingly recognized, there is little research on the measurement issues involved in operationalizing the dependence syndrome for this drug. This paper aimed to investigate the diagnostic utility and appropriate diagnostic cut-offs of three short dependence measures among long-term cannabis users. SETTING AND PARTICIPANTS: Two hundred long-term, regular cannabis users were recruited and interviewed in Sydney, Australia. MEASUREMENTS: Receiver Operating Characteristic analyses compared the diagnostic performance of the short University of Michigan CIDI, a measure of ICD-10 dependence and the Severity of Dependence Scale against the "gold standard" of moderate or more severe DSM-III-R cannabis dependence, as diagnosed by the Substance Abuse Module of the CIDI. FINDINGS: The measures were of equal utility in diagnosing at least moderate DSM-III-R cannabis dependence. While the optimal diagnostic cut-offs for the short University of Michigan CIDI and the ICD-10 dependence measure remained unchanged from those conventionally applied, a more liberal cut-off was optimal for the Severity of Dependence Scale. The amended prevalence of cannabis dependence was 77% using the short University of Michigan CIDI, 72% by the ICD-10 measure and 62% by the Severity of Dependence Scale. CONCLUSIONS: The three instruments were able to diagnose cannabis dependence at levels substantially better than chance. They were generally robust in terms of the optimal diagnostic cut-off in a population of long-term cannabis users. This paper provides guidelines for choosing optimal cut-offs within different contexts.

Adolescent↗
PubMed2002

Determining a diagnostic cut-off on the Severity of Dependence Scale (SDS) for cocaine dependence.

AIM: The study aimed to assess the efficacy of the Severity of Dependence Scale (SDS) as a diagnostic measure of cocaine dependence and determine the cut-off score that best discriminates between the presence and absence of a DSM-IV diagnosis of cocaine dependence. DESIGN: Cross-sectional survey. SETTING: Sydney, Australia. PARTICIPANTS: One hundred and forty-two cocaine users. MEASUREMENTS: The diagnostic performance of the SDS was measured via ROC analysis against DSM-IV diagnoses of cocaine dependence, as measured by the Composite International Diagnostic Interview (CIDI). FINDINGS: ROC analysis revealed the SDS to be a test of high diagnostic utility for the measurement of cocaine dependence. The cut-off point on the SDS at which there is optimal discrimination between the presence and absence of a DSM-IV diagnosis of cocaine dependence was found to be 3 (i.e. a score of 3 or more). CONCLUSIONS: The study statistically validated the utility of the SDS as a diagnostic measure of cocaine dependence and has determined an appropriate cut-off point. The SDS is recommended as a brief screening instrument for cocaine dependence that can be used in addition to more comprehensive measures, such as the CIDI.

Adolescent↗
PubMed2001

The role of 123I-diagnostic imaging in the follow-up of patients with differentiated thyroid carcinoma as compared to 131I-scanning: avoidance of negative therapeutic uptake due to stunning.

OBJECTIVE: Some patients with relapsed differentiated thyroid cancer may show rising thyroglobulin (Tg) levels despite a lack of 131I uptake on routine whole body imaging. A significant proportion of these patients, after therapy doses of 131I, may demonstrate positive 131I uptake with a subsequent fall in serum Tg, implying a therapeutic effect. Attempts to identify such patients by increasing the dose of the diagnostic 131I tracer may lead to inhibition of subsequent uptake after the therapy dose, an effect referred to as 'stunning' and associated with a reduction in therapeutic effect. 123I is a short half-life gamma-emitter, thought to be unlikely to cause stunning, which may thus be more suitable than 131I for diagnostic imaging of thyroid cancer. DESIGN AND PATIENTS: The efficacy of the 123I radionuclide was determined in a longitudinal study of 12 patients who were selected only because they showed elevated serum Tg and a negative diagnostic 131I whole body study prior to therapy with 131I. RESULTS: There was almost complete concordance in uptake between 123I diagnostic imaging and the final scans carried out after 131I therapy (hereafter known as therapy studies) in 11 out of 12 patients at their first evaluation, in each of four patients receiving 123I at their second evaluation and in a single patient receiving 123I at a third evaluation. One patient had a positive 123I study but a negative 131I therapy study: following therapy Tg declined from 5.5 pg/l to undetectable levels, implying a therapeutic effect, and suggesting that the negative uptake was not the result of stunning. Two negative diagnostic 123I studies were followed by negative therapy studies, and thus there were no false negatives. 123I correctly identified disease in the nine patients with metastases in the lungs, mediastinum and bone at the first evaluation, in all four patients at the second evaluation and in the single patient at the third evaluation. At the end of the study, patients had received up to three 131I therapy doses, Tg had risen in four patients, fallen in eight and become undetectable in one patient. CONCLUSIONS: 123I is highly sensitive in diagnosing local recurrence and metastatic disease, and produces scintigraphic images which concord well with uptake following 131I therapy. It is proposed that 123I imaging, in combination with serum Tg measurements, should replace 131I tracer imaging as an indicator of the potential efficacy of 131I therapy. Stunning, with its detrimental effects on 131I therapy, may thus be avoided. The possibility of false negative images due to the stunning phenomenon must always be borne in mind if there is a discrepancy between positive 131I imaging studies and a surprisingly negative subsequent 131I therapy scan.

Adult↗
PubMed2002

Telepathology: current status and future prospects in diagnostic histopathology.

Telepathology is the process of diagnostic histopathology performed on digital images viewed on a display screen rather than by conventional glass slide light microscopy. The technology of telepathology has radically improved over the past 5 years so that it is no longer the limiting factor in the diagnostic process. This review looks at the resources needed for dynamic and static telepathology, including image quality, computers and software interfaces, means of transmission and human resources. It critically analyses 32 published trials of telepathology, including some large prospective studies, in all areas of diagnostic histopathology including intraoperative frozen sections, routine and referral cases. New developments, including internet solutions and virtual microscopy, are described and there is analysis of the economics of telepathology within health care systems. The review concludes that all the necessary technology for telepathology is available, there is strong published evidence for a diagnostic accuracy comparable with glass slide diagnosis, in many contexts there is a clear-cut economic argument in favour of telepathology, and that the technique should now be integrated into mainstream diagnostic histopathology.

Humans↗
PubMed2003

Consumer information materials for diagnostic breast tests: women's views on information and their understanding of test results.

OBJECTIVES: To explore women's views on diagnostic breast test information and elicit their preferences for this information. DESIGN: In-depth, face-to-face interview. SETTING AND PARTICIPANTS: Thirty-seven women who had previously participated in a population-based telephone survey. MAIN OUTCOME MEASURES: Qualitative thematic analysis. RESULTS: Analysis of interview transcripts revealed information about: (1) the wide range of information participants wanted about diagnostic mammography; (2) general reactions to diagnostic breast test information, including positive and negative reactions, views of test accuracy information and perceived influences on information preferences; (3) preferences for information content and presentation including the need for written information, the meaning of statistical information, different views on a simple presentation style, and variation in preferences; and (4) women's understanding of diagnostic test results. CONCLUSION: Women want a range of information about diagnostic mammography, which is relevant at different times in the decision-making and testing process. Many women have difficulty interpreting test results.

Adult↗
PubMed2001

Diagnostic value of serum type IV collagen test in comparison with platelet count for predicting the fibrotic stage in patients with chronic hepatitis C.

BACKGROUND AND AIM: The serum type IV collagen test is now used as a diagnostic aid for the detection of liver fibrosis and cirrhosis. Recently, a platelet count has been reported to be a useful marker for assessing the fibrotic stage in chronic hepatitis C. The aim of this study was to compare the usefulness of the serum type IV collagen test and platelet count for diagnosing the fibrotic stage in chronic hepatitis C patients. METHODS: The diagnostic values were assessed by the use of receiver operating characteristic (ROC) analysis in 165 patients with chronic hepatitis C, with the exception of those patients with cirrhosis. RESULTS: The serum type IV collagen level increased, and the platelet count decreased significantly with the progression of fibrosis staging. As judged from ROC curves, the serum type IV collagen test was more useful than the platelet count for differentiating moderate or severe fibrosis from no or mild fibrosis. At a cut-off value of 110 ng/mL, the serum type IV collagen test had an overall diagnostic accuracy of 75%, while at a cut-off value of 16 x 10(4)/mm(3), the platelet count had a diagnostic accuracy of 70%. The serum type IV collagen test and platelet count were similar in differentiating severe fibrosis from no, mild or moderate fibrosis. Both serum type IV collagen (at a cut-off value of 130 ng/mL) and platelet count (at a cut-off value of 14 x 10(4)/mm(3)) had a diagnostic accuracy of 73%. CONCLUSION: The serum type IV collagen test was slightly superior to the platelet count for assessing the fibrotic stage in patients with chronic hepatitis C.

Adult↗
PubMed2003

A structural representation of migraine diagnostic criteria: the experts' view.

OBJECTIVE: To generate an empirically derived structural representation of migraine diagnostic criteria in a group of international headache experts using the Pathfinder network scaling algorithm in order to evaluate the validity of the migraine criteria used in the International Headache Society (IHS) classification system. BACKGROUND: Because it is a disease entity that lacks objective defining markers, developing valid diagnostic criteria for migraine is a challenge. The IHS committee relied on expert consensus to develop their classification system in 1988. Expert consensus also was used to evaluate the validity of the IHS classification system, but further studies employing alternative methods still are needed. METHODS: Headache experts representing the Executive Committee of the IHS and the Board of Directors of the American Headache Society analyzed 14 criteria (7 IHS and 7 non-IHS) considered relevant in diagnosing migraine. Their ratings were submitted to the Pathfinder algorithm to generate a network structure reflecting the experts' conceptualization of migraine diagnostic criteria. RESULTS: The expert network had 3 groupings: headache characteristics (eg, phonophobia, unilateral pain, throbbing pain), biological contributing factors (eg, family history, hormonal relationship, relief with sleep), and triggering factors (eg, worse with stress, food triggers). The IHS criteria were clustered together in the center portion of the network. A t test showed that each IHS criterion was closer conceptually to other IHS criteria than to non-IHS criteria. Graph theory indices revealed that the most central criteria were unilateral pain, moderate/severe intensity, and nausea/vomiting. CONCLUSION: The structural representation of migraine diagnostic criteria from these international headache experts is consistent with the migraine diagnostic criteria set forth in the IHS classification system and thus provides further support for the validity of migraine criteria in the IHS system.

Algorithms↗
PubMed2006

Integration of microfluidics with biomedical infrared spectroscopy for analytical and diagnostic metabolic profiling.

We describe how infrared spectroscopy of dry films (IRDF) can provide diagnostic information, and how we expect integration with laminar fluid diffusion interface (LFDI) sample pre-processing to generate new analytical and diagnostic tests. LFDI pre-processing provides sample clean-up and analyte separation. The sensitivity of IRDF to certain analytes is enhanced through the depletion of sample constituents that otherwise obscure relevant spectral features, permitting the deposition of films with larger sample volumes and, hence, of greater effective optical pathlength for the targeted analytes. An integrated LFDI-IRDF technology holds promise both as a method for rapid point-of-care quantitative analysis of biological fluids and as the engine of discovery for a wide range of novel diagnostic methods based upon metabolic profiling. In particular, successful integration will provide a versatile and cost effective technology platform that will allow for the accurate quantification of low-concentration analytes that are otherwise inaccessible and will provide the basis for diagnostic and prognostic methods that would otherwise be impossible. The specific question addressed by the proof-of-concept study summarised here is whether the spectra of LFDI processed samples can provide analytical methods that are more accurate than otherwise possible without LFDI pre-processing. The enrichment of serum creatinine is accomplished, with subsequent enhancement of its spectral contribution permitting quantification of this clinically important analyte beyond that achievable with no pre-processing. Finally, to illustrate the potential in diagnostic applications, two recently initiated studies are outlined, one involving chronic kidney disease and the other for chronic and acute coronary artery disease.

Biomarkers↗
PubMed2000

Diagnostic efficacy of (13)C-urea breath test for Helicobacter pylori infection in hemodialysis patients.

The noninvasive urea breath test (UBT) avoids the discomforts and risks of invasive endoscopic methods of Helicobacter pylori detection. This study investigated the diagnostic efficacy of carbon 13 ((13)C)-labeled UBT for H pylori detection in 70 patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) and 70 dyspeptic controls without renal impairment. With H pylori infection defined as a positive result on either histological examination or culture of gastric biopsy specimen, we evaluated the reliability of the (13)C-UBT in detecting H pylori infection in both groups. To ascertain whether HD therapy affects the diagnostic efficacy of the UBT, the test was performed twice in patients with ESRD (before and after HD) at least 72 hours apart. In each UBT session, the baseline, 10-minute, and 15-minute (Delta15) gas samples were obtained to analyze excess (13)CO(2)/(12)CO(2) ratio (ECR). Histological stain and/or culture studies found that 33 of the patients with ESRD (47. 1%) and 42 of the control patients (60%) had H pylori infection. (13)C-UBT for H pylori detection in patients with ESRD was found to be only 93.8% sensitive and 85.3% specific. These results were achieved by gas sampling (Delta15) after HD therapy with a cutoff ECR value greater than 5. Conversely, the UBT in the control group achieved the greatest diagnostic efficacy (sensitivity, 97.6%; specificity, 96.4%) with a comparatively lower ECR cutoff value of 4. We conclude that the diagnostic accuracy for H pylori detection in patients with ESRD could be improved by performing (13)C-UBT (Delta15) after HD therapy and assessing the UBT with a cutoff ECR value greater than 5. However, the diagnostic efficacy of the UBT for patients with ESRD remained less accurate than that for dyspeptic patients without renal impairment.

Adolescent↗
PubMed2000

Diagnostic accuracy of magnetic resonance cholangiopancreatography and ultrasound compared with direct cholangiography in the detection of choledocholithiasis.

AIM: To determine the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) and trans-abdominal ultrasound in the detection of choledocholithiasis, and to compare bile duct stone characteristics using endoscopic retrograde cholangiopancreatography (ERCP), MRCP and ultrasound. MATERIALS AND METHODS: Of 191 consecutive patients referred for diagnostic ERCP, choledocholithiasis was diagnosed in 34 patients using direct cholangiography. The latter took the form of ERCP (n = 29), intraoperative cholangiography (n = 3) or percutaneous transhepatic cholangiography (n = 2). All patients underwent MRCP and ultrasound examinations and their findings for choledocholitiasis were compared with those at direct cholangiography. Finally, in the 29 patients with choledocholithiasis diagnosed under ERCP, stone characteristics were compared across the three investigations of ERCP, MRCP and ultrasound. RESULTS: Compared with direct cholangiography, MRCP showed a sensitivity, specificity and diagnostic accuracy of 91%, 98% and 97%, respectively, in the diagnosis of choledocholithiasis. MRCP resulted in three false-negative and three false-positive findings, four of which occurred due to confusion with lesions at the ampulla. Ultrasound showed a sensitivity, specificity and diagnostic accuracy of 38%, 100% and 89%, respectively, in the diagnosis of choledocholithiasis. ERCP revealed a greater number of stones and these were more proximally distributed within the bile ducts when compared to MRCP. CONCLUSIONS: MRCP is highly accurate in the diagnosis of choloedocholithiasis and has the potential to replace diagnostic ERCP. MRCP underestimates the number of bile duct stones present.

Adult↗