Magnetic resonance cholangiopancreatography
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:
- identification of congenital anomalies of the cystic and hepatic ducts
- post-surgical biliary anatomy and complications
- pancreas divisum
- anomalous pancreaticobiliary junction
- biliary strictures
- chronic pancreatitis
- pancreatic cystic lesions
- trauma to biliary system
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.
Technique and protocols
No contrast is administered within the body.
Fasting for 4 hours prior to the examination is required to reduce gastroduodenal secretions, reduce motility to eliminate motion artifacts 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 sec) 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
- functional MRCP
- negative oral contrast to 'null' the duodenum
- commercially available agents
- natural products such as pineapple juice which is rich in manganese and shortens 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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- 5. Riordan RD, Khonsari M, Jeffries J et-al. Pineapple juice as a negative oral contrast agent in magnetic resonance cholangiopancreatography: a preliminary evaluation. Br J Radiol. 2005;77 (924): 991-9. Pubmed citation