Magnetic resonance cholangiopancreatography

Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive imaging technique to visualize intra and extrahepatic biliary tree and pancreatic ductal system.

It can provide the diagnostic range equivalent to the ERCP and so it can replace the ERCP in high risk patient to avoid significant morbidity.

MRCP can be used to evaluate various conditions of pancreatobiliary ductal system, some of them are:

The technique exploits the fluid which is present in the biliary and pancreatic ducts as a contrast agent by acquiring the images using heavily T2 weighted sequences. Since the fluid-filled structures in the abdomen have a long T2 relaxation time as compared to the surrounding soft tissue, these structures appear hyperintense than the surrounding on a heavily T2 weighted sequence and can easily be distinguished.

No contrast is administered within the body.

Fasting for 4 hours prior to the examination is required to reduce gastroduodenal secretions, reduce bowel peristalsis (and related motion artifact) and to promote distension of gall bladder. MRCP is performed on a 1.5 T or superior MRI system, using a phased-array body coil.

All protocols obtain heavily T2 weighted sequences. Most commonly obtained sequences are:

  • RARE: rapid acquisition and relaxation enhancement
  • FRFSE: fast-recovery fast spin-echo coronal oblique 3D respiratory triggered
  • HASTE: half-Fourier acquisition single shot turbo spin echo-axial 2D breath hold sequence which provide superior images and can be performed in single breath hold (<20 s) and a fat-suppressed sequence
  • additional sequence which can be acquired to evaluate duct wall is fat suppressed T1 GRE sequence

For optimum visualization of ducts, acquired images are reformatted in different planes using multiplanar reconstruction (MPR) and maximum intensity projection (MIP).

The advantage of FRFSE, as a 3D technique, is the ability to perform multiplanar reconstructions. However, despite respiratory triggering, this sequence is often prone to motion artifact.

With the evolution of MRCP, modified techniques came into existence. Commonly applied modified MRCP techniques are:

  • secretin-stimulated MRCP
    • secretin (administered intravenously) causes exocrine secretion of the pancreas, dilating the pancreatic duct and improving its visualization; indications include:1
      • ​detection/characterization of pancreatic duct anomalies/strictures
      • characterizing communications between the pancreatic duct and pseudocysts/fistulas
      • characterizing pancreatic and sphincter of Oddi dysfunction 
  • functional MRCP
    • intravenous administration of MR lipophylic paramagentic contrast agents which are then excreted by the hepato-biliary system
  • negative oral contrast to 'null' the duodenum
    • commercially available agents
    • natural products which are rich in manganese (e.g. pineapple or blueberry juice) shorten the T2 relaxation time

Artifacts related to technique and reconstruction, motion or susceptibility artifacts due to metal clips and gas may give rise to poor spatial resolution as a result of that misinterpretation.

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Article information

rID: 32557
Tag: pm
Synonyms or Alternate Spellings:
  • MRCP
  • Magnetic resonance cholangiopancreatography (MRCP)

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Cases and figures

  • Case 1: normal MRCP
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  • Long TE SS-FSE th...
    Case 2: pancreas divisum
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  • Case 3: negative oral contrast test image
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  • Case 4: showing CBD stones
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  • Case 5: CBD and gallbladder stones
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