Magnetic resonance cholangiopancreatography (MRCP)
Citation, DOI & article data
- Magnetic resonance cholangiopancreatography (MRCP)
- MRCP
Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive imaging technique to visualize the intra and extrahepatic biliary tree and pancreatic ductal system.
It can provide diagnostically-equivalent images to ERCP and and is a useful technique in high risk patients to avoid significant morbidity.
On this page:
Indications
MRCP can be used to evaluate various conditions of the pancreaticobiliary ductal system, some of which are:
- identification of congenital anomalies of the cystic and hepatic ducts
- post-surgical biliary anatomy and complications
- pancreas divisum
- anomalous pancreaticobiliary junction
- choledocholithiasis
- biliary strictures
- chronic pancreatitis
- pancreatic cystic lesions
- biliary or pancreatic trauma
Physics
The technique exploits the fluid which is present in the biliary and pancreatic ducts as an intrinsic contrast medium 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 against the surrounding non-fluid-containing tissues on a heavily T2-weighted sequence and can easily be distinguished.
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Technique and protocols
No exogenous contrast medium is administered to the patient.
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 the gallbladder. 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
- an additional sequence that can be acquired to evaluate the duct wall is a fat suppressed T1 GRE sequence
- T1 sequences may also help differentiate biliary calculi from pneumobilia 7
For optimal 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.
Technical modifications
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 or strictures
- characterizing communications between the pancreatic duct and pseudocysts/fistulas
- characterizing pancreatic and sphincter of Oddi dysfunction
- secretin (administered intravenously) causes exocrine secretion of the pancreas, dilating the pancreatic duct and improving its visualization; indications include 1:
- functional MRCP
- intravenous administration of MR lipophilic paramagnetic contrast agents which are then excreted by the hepatobiliary 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
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Practical points
Artifacts related to technique and reconstruction, and motion or susceptibility artifacts due to metal clips and gas, may give rise to poor spatial resolution and limited interpretation. Reviewing thin section and multiple planes may help overcome some of these issues 6.
Quiz questions
References
- 1. Griffin N, Charles-Edwards G, Grant LA. Magnetic resonance cholangiopancreatography: the ABC of MRCP. Insights Imaging. 2012;3 (1): 11-21. doi:10.1007/s13244-011-0129-9 - Free text at pubmed - Pubmed citation
- 2. Maccioni F, Martinelli M, Al Ansari N et-al. Magnetic resonance cholangiography: past, present and future: a review. Eur Rev Med Pharmacol Sci. 2010;14 (8): 721-5. Pubmed citation
- 3. Hintze RE, Adler A, Veltzke W et-al. Clinical significance of magnetic resonance cholangiopancreatography (MRCP) compared to endoscopic retrograde cholangiopancreatography (ERCP). Endoscopy. 1997;29 (03): 182-7. doi:10.1055/s-2007-1004160 - Pubmed citation
- 4. 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 (1): 17-22. doi:10.1067/mge.2002.120324 - Pubmed citation
- 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
- 6. Bruno P.C. Vidal, Daniel Lahan-Martins, Thiago J. Penachim, Marco Alexandre M. Rodstein, Patrícia P. Cardia, Adilson Prando. MR Cholangiopancreatography: What Every Radiology Resident Must Know. (2020) RadioGraphics. 40 (5): 1263-1264. doi:10.1148/rg.2020200030 - Pubmed
- 7. Erden A, Haliloğlu N, Genç Y, Erden I. Diagnostic value of T1-weighted gradient-echo in-phase images added to MRCP in differentiation of hepatolithiasis and intrahepatic pneumobilia. (2014) AJR. American journal of roentgenology. 202 (1): 74-82. doi:10.2214/AJR.12.10359 - Pubmed
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