The use of different pathology classification systems in preoperative imaging of Mirizzi syndrome.

Background: The aim was to evaluate the diagnostic value of the Nakagawa and Csendes pathology classification systems in preoperative imaging of Mirizzi syndrome. Mirizzi syndrome is a type of biliary system obstruction caused by stones impacted in a gallbladder neck or cystic duct situated parallel to the common bile duct, causing extrinsic common bile duct stenosis or obstruction, which can lead to recurrent obstructive jaundice, bile duct erosion, and cholangitis. Therefore, the preoperative identification and classification of Mirizzi syndrome is vital for a good surgical result. We explored the applicability of two pathological classification systems to diagnostic imaging.

Methods: We performed a retrospective analysis of the clinical, computed tomography, and magnetic resonance imaging data of 76 cases of pathologically confirmed Mirizzi syndrome, comparing the applicability of the Csendes and Nakagawa pathology classification systems to preoperative imaging.

Results: The Nagakawa pathology classification system had higher sensitivity, specificity, accuracy, positive predictive value, and positive likelihood ratio, along with lower rates of both missed diagnosis and misdiagnosis. Its positive predictive value and positive likelihood ratios were significantly superior. Adapting the Nagakawa pathological classification system to preoperative imaging produced more consistent results than the Csendes system.

Conclusions: Compared with the Csendes pathology classification system, the Nagakawa classification is more adaptable to preoperative imaging and treatment planning.