Magnetic resonance cholangiopancreatography
- Umaprasanna S Karnam, MD
Umaprasanna S Karnam, MD
- Jordan Valley Hospital
- West Jordan, UT
- K Rajender Reddy, MD
K Rajender Reddy, MD
- Ruimy Family President's Distinguished Professor of Medicine
- Professor of Medicine in Surgery
- Director of Hepatology
- Director, Viral Hepatitis Center
- Medical Director of Liver Transplantation
- University of Pennsylvania School of Medicine
- Stephan Anderson, MD
Stephan Anderson, MD
- Professor of Radiology
- Boston University School of Medicine
- Section Editors
- Douglas A Howell, MD, FASGE, FACG
Douglas A Howell, MD, FASGE, FACG
- Section Editor — EUS/ERCP
- Assistant Clinical Professor of Medicine, Tufts Medical School Director,
- Pancreaticobiliary Center Director, Advanced Interventional Endoscopy Fellowship, Maine Medical Center
- Jonathan B Kruskal, MD, PhD
Jonathan B Kruskal, MD, PhD
- Section Editor — Kidney Disease
- Professor of Radiology
- Harvard Medical School
Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive technique for evaluating the intrahepatic and extrahepatic bile ducts and the pancreatic duct .
Unlike conventional endoscopic retrograde cholangiopancreatography (ERCP), MRCP does not require contrast material to be administered into the ductal system. Thus, the morbidity associated with endoscopic procedures and contrast materials is avoided. However, MRCP does not permit interventions to be performed such as stone extraction, stent insertion, or biopsy.
Since the introduction of MRCP in 1991, technological refinements have made it an extremely useful modality in the evaluation of the hepatobiliary tree. The technique was initially performed with the use of heavily T2-weighted magnetic resonance pulse sequences. These had the effect of making stationary or slow-flowing fluid within the bile and pancreatic ducts to appear very bright relative to the low-signal intensity produced by adjacent solid tissues [2-4]. With the specific image acquisition sequences used, flowing blood had little or no measurable signal; as a result, blood vessels were not mistaken for bile or pancreatic ducts. The ducts could be visualized from multiple projections, thereby duplicating cholangiographic images noninvasively.
However, this method was limited in its ability to detect non-dilated bile ducts because of a low signal-to-noise ratio and sensitivity to motion artifacts. Newer variants of magnetic resonance, including the rapid acquisition with relaxation enhancement (RARE) and half-Fourier acquisition single-shot turbo spin-echo (HASTE), provide superior images. Single-shot RARE and HASTE techniques can be performed in a breath-hold period with a scan time of <20 seconds.
Imaging protocols — The optimal protocol to perform MRCP has not been defined, and there continues to be variation across centers. As a general rule, the protocol depends upon the specific magnetic resonance magnet being used, including its field strength (eg, 1.5 versus 3T) and the manufacturer, as well as institutional experience and preferences. However, all acquisition protocols obtain heavily T2-weighted images as thick slabs, and the images are reformatted in planes to optimize depiction of the extrahepatic ducts. Volume-rendered images may be used to depict the intra- and extrahepatic bile ducts.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Barish MA, Yucel EK, Ferrucci JT. Magnetic resonance cholangiopancreatography. N Engl J Med 1999; 341:258.
- Reinhold C, Bret PM. Current status of MR cholangiopancreatography. AJR Am J Roentgenol 1996; 166:1285.
- Bret PM, Reinhold C. Magnetic resonance cholangiopancreatography. Endoscopy 1997; 29:472.
- Wallner BK, Schumacher KA, Weidenmaier W, Friedrich JM. Dilated biliary tract: evaluation with MR cholangiography with a T2-weighted contrast-enhanced fast sequence. Radiology 1991; 181:805.
- Bowes MT, Martin DF, Melling A, et al. Single dose oral ranitidine improves MRCP image quality: a double-blind study. Clin Radiol 2007; 62:53.
- Dalal PU, Howlett DC, Sallomi DF, et al. Does intravenous glucagon improve common bile duct visualisation during magnetic resonance cholangiopancreatography? Results in 42 patients. Eur J Radiol 2004; 49:258.
- Lee Y, Kim SY, Kim KW, et al. Contrast-enhanced MR cholangiography with Gd-EOB-DTPA for preoperative biliary mapping: correlation with intraoperative cholangiography. Acta Radiol 2015; 56:773.
- Kantarcı M, Pirimoglu B, Karabulut N, et al. Non-invasive detection of biliary leaks using Gd-EOB-DTPA-enhanced MR cholangiography: comparison with T2-weighted MR cholangiography. Eur Radiol 2013; 23:2713.
- Gupta RT. Evaluation of the biliary tree and gallbladder with hepatocellular MR contrast agents. Curr Probl Diagn Radiol 2013; 42:67.
- Miyazaki T, Yamashita Y, Tsuchigame T, et al. MR cholangiopancreatography using HASTE (half-Fourier acquisition single-shot turbo spin-echo) sequences. AJR Am J Roentgenol 1996; 166:1297.
- Hintze RE, Adler A, Veltzke W, et al. Clinical significance of magnetic resonance cholangiopancreatography (MRCP) compared to endoscopic retrograde cholangiopancreatography (ERCP). Endoscopy 1997; 29:182.
- Taylor AC, Little AF, Hennessy OF, et al. Prospective assessment of magnetic resonance cholangiopancreatography for noninvasive imaging of the biliary tree. Gastrointest Endosc 2002; 55:17.
- Hall-Craggs MA, Allen CM, Owens CM, et al. MR cholangiography: clinical evaluation in 40 cases. Radiology 1993; 189:423.
- Guibaud L, Bret PM, Reinhold C, et al. Bile duct obstruction and choledocholithiasis: diagnosis with MR cholangiography. Radiology 1995; 197:109.
- Becker CD, Grossholz M, Becker M, et al. Choledocholithiasis and bile duct stenosis: diagnostic accuracy of MR cholangiopancreatography. Radiology 1997; 205:523.
- Lomanto D, Pavone P, Laghi A, et al. Magnetic resonance-cholangiopancreatography in the diagnosis of biliopancreatic diseases. Am J Surg 1997; 174:33.
- Varghese JC, Farrell MA, Courtney G, et al. A prospective comparison of magnetic resonance cholangiopancreatography with endoscopic retrograde cholangiopancreatography in the evaluation of patients with suspected biliary tract disease. Clin Radiol 1999; 54:513.
- Coakley FV, Schwartz LH, Blumgart LH, et al. Complex postcholecystectomy biliary disorders: preliminary experience with evaluation by means of breath-hold MR cholangiography. Radiology 1998; 209:141.
- Romagnuolo J, Bardou M, Rahme E, et al. Magnetic resonance cholangiopancreatography: a meta-analysis of test performance in suspected biliary disease. Ann Intern Med 2003; 139:547.
- Chard PS, Qayyum A, Mein S, et al. Magnetic resonance cholangiopancreatography for the noninvasive evaluation of liver transplant patients with suspected biliary strictures: A prospective Double-blind study. Gastroenterology 2004; 126:649.
- David V, Reinhold C, Hochman M, et al. Pitfalls in the interpretation of MR cholangiopancreatography. AJR Am J Roentgenol 1998; 170:1055.
- Rösch T, Meining A, Frühmorgen S, et al. A prospective comparison of the diagnostic accuracy of ERCP, MRCP, CT, and EUS in biliary strictures. Gastrointest Endosc 2002; 55:870.
- Yeh TS, Jan YY, Tseng JH, et al. Malignant perihilar biliary obstruction: magnetic resonance cholangiopancreatographic findings. Am J Gastroenterol 2000; 95:432.
- Lopera JE, Soto JA, Múnera F. Malignant hilar and perihilar biliary obstruction: use of MR cholangiography to define the extent of biliary ductal involvement and plan percutaneous interventions. Radiology 2001; 220:90.
- Fulcher AS, Turner MA, Capps GW, et al. Half-Fourier RARE MR cholangiopancreatography: experience in 300 subjects. Radiology 1998; 207:21.
- Ernst O, Asselah T, Sergent G, et al. MR cholangiography in primary sclerosing cholangitis. AJR Am J Roentgenol 1998; 171:1027.
- Vitellas KM, Keogan MT, Freed KS, et al. Radiologic manifestations of sclerosing cholangitis with emphasis on MR cholangiopancreatography. Radiographics 2000; 20:959.
- Elsayes KM, Oliveira EP, Narra VR, et al. MR and MRCP in the evaluation of primary sclerosing cholangitis: current applications and imaging findings. J Comput Assist Tomogr 2006; 30:398.
- Chan YL, Chan AC, Lam WW, et al. Choledocholithiasis: comparison of MR cholangiography and endoscopic retrograde cholangiography. Radiology 1996; 200:85.
- Lee MG, Lee HJ, Kim MH, et al. Extrahepatic biliary diseases: 3D MR cholangiopancreatography compared with endoscopic retrograde cholangiopancreatography. Radiology 1997; 202:663.
- Varghese JC, Liddell RP, Farrell MA, et al. Diagnostic accuracy of magnetic resonance cholangiopancreatography and ultrasound compared with direct cholangiography in the detection of choledocholithiasis. Clin Radiol 2000; 55:25.
- Moon JH, Cho YD, Cha SW, et al. The detection of bile duct stones in suspected biliary pancreatitis: comparison of MRCP, ERCP, and intraductal US. Am J Gastroenterol 2005; 100:1051.
- Barish MA, Yucel EK, Soto JA, et al. MR cholangiopancreatography: efficacy of three-dimensional turbo spin-echo technique. AJR Am J Roentgenol 1995; 165:295.
- Soto JA, Yucel EK, Barish MA, et al. MR cholangiopancreatography after unsuccessful or incomplete ERCP. Radiology 1996; 199:91.
- Park MS, Yu JS, Kim YH, et al. Acute cholecystitis: comparison of MR cholangiography and US. Radiology 1998; 209:781.
- Soto JA, Barish MA, Yucel EK, et al. Pancreatic duct: MR cholangiopancreatography with a three-dimensional fast spin-echo technique. Radiology 1995; 196:459.
- Bret PM, Reinhold C, Taourel P, et al. Pancreas divisum: evaluation with MR cholangiopancreatography. Radiology 1996; 199:99.
- Adamek HE, Albert J, Breer H, et al. Pancreatic cancer detection with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography: a prospective controlled study. Lancet 2000; 356:190.
- Vasen HF, Wasser M, van Mil A, et al. Magnetic resonance imaging surveillance detects early-stage pancreatic cancer in carriers of a p16-Leiden mutation. Gastroenterology 2011; 140:850.
- Cheon YK, Cho KB, Watkins JL, et al. Frequency and severity of post-ERCP pancreatitis correlated with extent of pancreatic ductal opacification. Gastrointest Endosc 2007; 65:385.
- Soto JA, Alvarez O, Múnera F, et al. Traumatic disruption of the pancreatic duct: diagnosis with MR pancreatography. AJR Am J Roentgenol 2001; 176:175.
- Rekhi S, Anderson SW, Rhea JT, Soto JA. Imaging of blunt pancreatic trauma. Emerg Radiol 2010; 17:13.
- Drake LM, Anis M, Lawrence C. Accuracy of magnetic resonance cholangiopancreatography in identifying pancreatic duct disruption. J Clin Gastroenterol 2012; 46:696.
- Czakó L, Endes J, Takács T, et al. Evaluation of pancreatic exocrine function by secretin-enhanced magnetic resonance cholangiopancreatography. Pancreas 2001; 23:323.
- De Vitis I, Spada C, Manfredi R, et al. Morpho-functional evaluation of chronic pancreatitis in early phases with MRCP after Secretin stimulation. Gastroenterology 2001; 120:59.
- Manfredi R, Costamagna G, Brizi MG, et al. Severe chronic pancreatitis versus suspected pancreatic disease: dynamic MR cholangiopancreatography after secretin stimulation. Radiology 2000; 214:849.
- Czakó L, Takács T, Morvay Z, et al. Diagnostic role of secretin-enhanced MRCP in patients with unsuccessful ERCP. World J Gastroenterol 2004; 10:3034.
- Mariani A, Curioni S, Zanello A, et al. Secretin MRCP and endoscopic pancreatic manometry in the evaluation of sphincter of Oddi function: a comparative pilot study in patients with idiopathic recurrent pancreatitis. Gastrointest Endosc 2003; 58:847.
- Fukukura Y, Fujiyoshi F, Sasaki M, Nakajo M. Pancreatic duct: morphologic evaluation with MR cholangiopancreatography after secretin stimulation. Radiology 2002; 222:674.
- Testoni PA, Mariani A, Curioni S, et al. MRCP-secretin test-guided management of idiopathic recurrent pancreatitis: long-term outcomes. Gastrointest Endosc 2008; 67:1028.
- Testoni PA, Mariani A, Curioni S, et al. Pancreatic ductal abnormalities documented by secretin-enhanced MRCP in asymptomatic subjects with chronic pancreatic hyperenzymemia. Am J Gastroenterol 2009; 104:1780.
- Imaging protocols
- Contrast agents
- CLINICAL USE
- Bile duct obstruction
- Malignant hilar and perihilar obstruction
- Patients with known or suspected PSC
- Common bile duct stones
- Acute cholecystitis
- Pancreatitis and pancreatic cancer
- Pancreatic duct disruption
- Secretin-enhanced MRCP
- SUMMARY AND RECOMMENDATIONS