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.
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- 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