ADVANCED IMAGING CENTER PHYSICIAN NEWS

September 25, 2000

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Advanced Topics in GI Radiology: MR CholangioPancreatography (MRCP)

A normal MRCP showing the gallbladder, common bile duct, hepatic ducts, and pancreatic duct. Choledocholithiasis and cholelithiasis. Ultrasound (not shown) revealed GB stones and bile duct dilatation but no bile duct stones. MR cholangiogram demonstrates multiple stones in both the gallbladder (arrowheads) and in the dilated extrahepatic bile duct (arrows). A large duodenal diverticulum shown on an MRCP (arrow).

Q.     What is MRCP?

MRCP or MR CholangioPancreatography (MR cholangiogram) is a noninvasive ultrafast MR technique for imaging of the pancreaticobiliary tree. It is the MRI version of ERCP without any IV or oral injections.

Q.     What MRI technique is utilized in MRCP?

Ultrafast techniques such as HAlf-Fourier Single-shot Turbo Spin Echo (HASTE). The study is performed in a few seconds on AIC’s high-field 1.5 Tesla short-bore Siemens Symphony in a breathhold. Single thick-slab and multi-thin-slice sequences are utilized in axial and coronal planes.

Q.     How does it compare to ERCP?

Diagnostically, it is as accurate, but obviously it is not therapeutic.

Q.     What are some applications for MRCP?

• Common duct stones. Gallstones (including impacted stones in the neck or cystic duct not visible by ultrasound).
• Intra or extrahepatic biliary dilatation. Cholangitis.
• Pancreas Divisum. Pancreatic duct dilatation.

Q.     What are some of the advantages of MRCP?

• Noninvasive … no IV or oral injections. No complications.
• 4D reformation allows viewing in 4D and at multiple angles.
• Allows for simultaneous MR imaging of the abdomen (liver, pancreas, etc.) for detection of possible masses, fluid collections, abscesses, pseudocysts, etc… not possible with ERCP.
• If positive, generates referrals for gastroenterologists and surgeons.

Q.     When would you use MRCP as the initial test?

Here are some circumstances when MRCP is used as the initial test:

1. In patients who have contraindications to ERCP.
2. Children or older patients.
3. Suspect stone in the bile duct (if MRCP negative, stop; if positive, stone extraction with ERCP or surgery).

For more information, please call me personally at (661) 949-8111.

Ray Hashemi, MD, PhD,
Director