What is a Magnetic Resonance Cholangiopancreatography (MRCP)?

From the Guidelines

Magnetic Resonance Cholangiopancreatography (MRCP) is a non-invasive imaging technique that uses MRI technology to visualize the biliary and pancreatic ducts, and it is the preferred diagnostic test for conditions such as sclerosing cholangitis, with a pooled sensitivity and specificity of 86% and 94%, respectively, as reported in a meta-analysis 1.

Key Features of MRCP

• Non-invasive procedure that does not require the insertion of instruments into the body
• Uses powerful magnets and radio waves to create detailed cross-sectional images of the biliary and pancreatic ducts
• Does not require contrast dye injection directly into the ducts, making it safer with fewer complications
• Typically takes 15-45 minutes to complete, with patients needing to fast for several hours beforehand
• Especially useful for detecting gallstones, strictures, tumors, cysts, and other abnormalities in the biliary and pancreatic systems

Advantages of MRCP

• Non-invasive nature, lack of radiation use, and lower cost compared to endoscopic retrograde cholangiopancreaticography (ERCP) 1
• Can be used as a quick standalone non-contrast test to diagnose conditions such as primary sclerosing cholangitis (PSC) 1
• Can provide information on bile duct thickness and enhancement, the status of hepatic parenchyma, and complications of liver disease, including evidence of portal hypertension 1

Limitations of MRCP

• Poor visualization of peripheral intrahepatic branches, which limits the ability to diagnose very early intrahepatic PSC 1
• False-positive findings in cirrhosis of any etiology due to tapering and duct distortion 1

Clinical Applications of MRCP

• Diagnosis of conditions such as PSC, cholangiocarcinoma, and pancreatic cancer 1
• Evaluation of bile duct obstruction and jaundice 1
• Detection of gallstones, strictures, tumors, cysts, and other abnormalities in the biliary and pancreatic systems 1

From the Research

Definition of MRCP

• Magnetic Resonance Cholangiopancreatography (MRCP) is a non-invasive imaging technique for the study of biliopancreatic disorders, providing projectional images of the biliary tree and pancreatic duct without any contrast agent 2.
• MRCP is able to provide projection images of the bile and pancreatic ducts, and is used to evaluate common bile duct obstruction, choledocholithiasis, benign and malignant strictures, and chronic pancreatitis 3, 4, 5.

Clinical Applications of MRCP

• The main indication for MRCP imaging is in the evaluation of common bile duct obstruction, with the aim of assessing the presence of the obstruction, its level, and its cause 2, 5.
• MRCP is useful in cases with severe biliary obstruction to evaluate the ducts proximal to the obstruction, and is the examination of choice in a setting where ERCP is difficult or impossible 6.
• MRCP can be used to detect extraductal disease when combined with conventional T1- and T2-weighted sequences 6.

Advantages of MRCP

• MRCP is non-invasive, cheaper, uses no radiation, requires no anaesthesia, and is less operator dependent compared to ERCP 6.
• MRCP can completely replace diagnostic ERCP in some cases, and has a high diagnostic accuracy in choledocholithiasis and malignant strictures 2, 4.

Technical Aspects of MRCP

• Different sequences, using both breath-hold and non-breath-hold acquisition techniques, have been employed in order to obtain MRCP images 2, 5.
• Three-dimensional non-breath-hold techniques and two-dimensional breath-hold, multi-slice and thick slab sequences are used to acquire MRCP images 5.