A Comparative Study of Ultrasound, Computed Tomography, and Magnetic Resonance Cholangiopancreatography in Detecting the Etiology of Obstructive Jaundice

A bstract Background: Obstructive jaundice comprises conditions that impair bile flow into the duodenum due to intrahepatic or extrahepatic obstruction. Objectives: To assess the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) compared with helical computed tomography (CT) and ultrasound (USG) in evaluating causes, extent, and biliary tract anomalies in obstructive jaundice. Materials and Methods: A cross-sectional study was conducted on 108 patients with obstructive jaundice across different age groups. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of MRCP, CT, and USG were determined. Statistical significance was set at p < 0.05. Results: Malignancy was the leading cause of obstructive jaundice (55.6%), most commonly periampullary carcinoma (40%) and cholangiocarcinoma (30%). Less frequent causes included metastatic compression and carcinoma of the pancreatic head (5% each). Benign etiologies were led by choledocholithiasis and cholelithiasis with choledocholithiasis (25% each), followed by benign stricture and choledochal cyst (18.8% each), with hepatic cyst compression of the common bile duct/common hepatic duct (CBD/CHD) and cholangitis being rare (6.3% each). MRCP with MRI achieved the highest diagnostic accuracy for malignancy (98.1%), compared with CT (91.7%) and USG (74%) (p < 0.001). For benign causes, MRCP similarly outperformed CT (91.7%) and USG (87%), with an accuracy of 98.1% (p < 0.001). Conclusion: Malignancy, particularly periampullary carcinoma and cholangiocarcinoma, was the predominant cause of obstructive jaundice, while choledocholithiasis was the most common benign etiology. MRCP with MRI demonstrated superior diagnostic performance over CT and USG, establishing it as the preferred imaging modality.