Comparison of the diagnostic efficacy of multislice spiral CT, magnetic resonance cholangiopancreatography, and endoscopic retrograde cholangiopancreatography in detecting small common bile duct stones

Objective The present study aimed to perform a methodical evaluation and comparison of the diagnostic performance exhibited by multidetector row computed tomography (MSCT), magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiopancreatography (ERCP) for distinguishing microlithiasis in the common bile duct. Methods In this retrospective study, it enrolled a cohort consisting of 255 subjects who were referred to our institution with suspicion of microlithiasis in the common bile duct; their hospital admissions occurred between June 2021 and June 2025. The diagnostic criteria established for this investigation were based on findings obtained through ERCP examinations. The diagnostic performances of MSCT, MRCP, and ERCP for common bile duct small stones (measuring >3–8 mm in size) and microlithiasis (≤3 mm in diameter) were assessed in an individual manner. Receiver operating characteristic (ROC) curves were plotted in order to assess and compare the corresponding areas under these curves (AUCs). Results ERCP demonstrated significantly superior diagnostic performance for both small stones (AUC = 0.96) and microlithiasis (AUC = 0.90) compared with MRCP (AUC = 0.89 and 0.81, respectively) and MSCT (AUC = 0.81 and 0.72, respectively) ( P < 0.05 for all pairwise comparisons using DeLong's test). for both small stones (AUC = 0.96) and microlithiasis (AUC = 0.90) compared with MRCP (AUC = 0.89 and 0.81, respectively) and MSCT (AUC = 0.81 and 0.72, respectively) ( P < 0.05). The diagnostic performance of MRCP demonstrated a markedly superior level of effectiveness when compared to the diagnostic performance of MSCT in the evaluated study ( P < 0.05). Conclusion ERCP constituted the most effective strategy for identifying microlithiasis within the common bile duct. MRCP was capable of acting as a dependable non-invasive preliminary screening instrument, while MSCT displayed restricted capability in the detection of microlithiasis and required careful utilization in clinical scenarios.