From the Guidelines
Magnetic Resonance Cholangiopancreatography (MRCP) should be obtained in adult patients presenting with elevated serum markers of cholestasis, particularly when a diagnosis of large duct Primary Sclerosing Cholangitis (PSC) is suspected, as it is the preferred diagnostic test according to the EASL clinical practice guidelines 1. When evaluating patients for MRCP, it is essential to consider the presence of typical findings of sclerosing cholangitis on high-quality cholangiography and the exclusion of secondary causes. The guidelines recommend MRCP as the preferred diagnostic test due to its high sensitivity and specificity for diagnosing PSC, with a pooled sensitivity and specificity of 86% and 94%, respectively 1. Some key points to consider when deciding to perform an MRCP include:
- Elevated serum markers of cholestasis, such as serum alkaline phosphatase (ALP) and gamma-glutamyltransferase (GGT) 1
- Presence of symptoms like right upper quadrant abdominal pain, jaundice, and/or pruritus 1
- Exclusion of secondary causes of sclerosing cholangitis 1
- Consideration of concomitant inflammatory bowel disease (IBD), as 50-80% of people with PSC also have IBD 1 The advantages of MRCP over other diagnostic tests, such as Endoscopic Retrograde Cholangiopancreatography (ERCP), include its non-invasive nature, lack of radiation use, and lower cost, making it a preferred choice for diagnostic purposes 1.
From the Research
Indications for MRCP
The following are indications for Magnetic Resonance Cholangiopancreatography (MRCP):
- Obstructive jaundice [(2,3,4,5,6)]
- Benign or malignant bilio-pancreatic ducts abnormalities [(2,3,4,5,6)]
- Choledocholithiasis [(2,3,4,5,6)]
- Iatrogenic strictures [(2,3,4,5,6)]
- Cholangiocarcinoma or pancreatic carcinoma [(2,3,4,5,6)]
- Assessment of the exocrine pancreatic function 4
- Evaluation of biliary-enteric anastomoses [(2,3,6)]
- Diagnosis of pancreas divisum 2
- Chronic pancreatitis [(2,3,6)]
Diagnostic Features
MRCP can diagnose various conditions, including:
- Bile duct stones as small as 2 mm 3
- Benign strictures due to sclerosing cholangitis 2
- Malignant strictures [(2,3,6)]
- Pancreatic pseudocysts 2
- Biliary cystadenomas and cystadenocarcinomas 2
- Anatomical variants and malformations 3
- Inflammatory conditions, such as sclerosing cholangitis and Mirizzi syndrome 3
Advantages of MRCP
MRCP has several advantages, including:
- Noninvasive [(2,3,4,5,6)]
- No need for contrast material or ionizing radiation 4
- High sensitivity and accuracy in detecting various conditions [(2,3,4,5,6)]
- Can be used to evaluate the entire pancreaticobiliary tract during a single breath hold 5
- Can provide a detailed map of the biliary tract for better treatment planning 6