What is Magnetic Resonance Cholangiopancreatography (MRCP)?

From the Guidelines

Magnetic Resonance Cholangiopancreatography (MRCP) is a non-invasive imaging technique that is the preferred diagnostic modality for visualizing the biliary and pancreatic ducts, particularly for diagnosing conditions such as primary sclerosing cholangitis (PSC) 1.

Key Features of MRCP

• MRCP uses magnetic resonance imaging to create detailed images of the biliary and pancreatic ducts without requiring contrast injection into the ducts.
• It is primarily used to diagnose conditions affecting the liver, gallbladder, bile ducts, pancreas, and pancreatic duct.
• The scan usually takes 15-45 minutes, during which patients lie still in the MRI machine.
• MRCP is particularly valuable for detecting:
  • Gallstones
  • Bile duct obstructions
  • Tumors
  • Strictures
  • Congenital abnormalities
  • Chronic pancreatitis

Advantages of MRCP

• Non-invasive nature
• Lack of radiation use
• Lower cost compared to ERCP
• Potential to add MR elastography (MRE) for further information on disease staging and prognosis

Limitations of MRCP

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

Recommendations

• MRCP is recommended as the primary diagnostic modality for PSC, with a pooled sensitivity and specificity of 86% and 94%, respectively 1.
• ERCP can be considered if MRCP plus liver biopsy is equivocal or contraindicated in patients with persisting clinical suspicion of PSC 1.
• MRCP should be considered before therapeutic ERCP in patients with an established diagnosis of PSC 1.

From the Research

Definition of Magnetic Resonance Cholangiopancreatography (MRCP)

• MRCP is a noninvasive diagnostic modality used to visualize the biliary and pancreatic ducts 2, 3, 4, 5, 6
• It uses MR imaging to visualize fluid in the biliary and pancreatic ducts as high signal intensity on T2 weighted sequences 3

Clinical Applications of MRCP

• MRCP is useful in the evaluation of pancreatic and biliary system disorders, including congenital anomalies, stones, and tumors 3, 4, 6
• It can accurately demonstrate the normal pancreatic duct as well as various pancreatic duct abnormalities, including stenosis, dilatation, and filling defects 4
• MRCP is also useful in diagnosing mucin-producing tumors of the pancreas, cystic lesions, and depicting the whole pancreaticobiliary tract, including the part distal to the obstructed site 4

Comparison with Endoscopic Retrograde Cholangiopancreatography (ERCP)

• MRCP is a noninvasive alternative to ERCP, which is an invasive test with appreciable complications 2, 3, 5
• While ERCP is superior to MRCP in some cases, such as diagnosing benign or malignant strictures, MRCP has its own advantages, such as being able to visualize the entire pancreaticobiliary tract during a single breath hold 2, 3
• MRCP can accurately and noninvasively delineate pancreaticobiliary ductal anatomy and diagnose pancreaticobiliary neoplasms comparably to ERCP 6

Patient Selection for MRCP

• MRCP is not practical or cost-effective for investigating all patients with gallstone disease, but it can be useful in selecting patients who are at high risk of having intra common bile duct stones (ICSs) 5
• Patients with normal liver biochemistry and normal ultrasound are unlikely to have ICSs and should not proceed to ERCP 5