What is a Magnetic Resonance Cholangiopancreatography (MRCP)?

From the Guidelines

MRCP stands for Magnetic Resonance Cholangiopancreatography, a non-invasive imaging technique used to visualize the biliary and pancreatic ducts, and is preferred over ERCP for diagnostic purposes due to its high sensitivity and specificity, as well as the absence of radiation exposure and risk of complications like pancreatitis 1.

Key Features of MRCP

• Uses magnetic resonance imaging (MRI) technology to create detailed images of the liver, gallbladder, bile ducts, pancreas, and pancreatic duct
• Typically takes 30-45 minutes to perform
• Requires patients to lie still inside an MRI machine while images are captured
• Patients usually need to fast for 4-6 hours before the procedure to ensure the gallbladder is not contracted
• Valuable for diagnosing conditions like gallstones, bile duct obstructions, pancreatic tumors, and chronic pancreatitis

Advantages of MRCP

• High sensitivity and specificity for diagnosing PSC, with a sensitivity of 0.86 and specificity of 0.94, respectively 1
• No risk of complications like pancreatitis, which can occur with ERCP
• No radiation exposure, making it a safer option for patients
• Can be used to guide directed approaches, such as ERCP, with brushing, percutaneous transhepatic biliary stenting, or reconstructive surgery 1

Limitations of MRCP

• Cannot be used for therapeutic interventions, unlike ERCP
• May have diminishing sensitivity with decreasing stone sizes of <4 mm 1
• May not be as accurate as ERCP for detecting tiny CBD stones, with a reported sensitivity ranging from 77% to 88% and specificity between 50% to 72% 1

From the Research

Definition of MRCP

• Magnetic Resonance Cholangiopancreatography (MRCP) is a non-invasive imaging technique for evaluating the biliary and pancreatic ducts 2, 3, 4, 5, 6
• It is used for the non-invasive work-up of patients with pancreaticobiliary disease 3

Uses of MRCP

• MRCP is used to evaluate the biliary and pancreatic ducts for various pathologies such as obstructive jaundice, chronic/acute pancreatitis, and screening prior to laparoscopic cholecystectomy 2
• It is also used to detect biliary dilatation, calculi, strictures, and anatomical variants 2, 3, 6
• MRCP can accurately identify the level of biliary obstruction and characterize the benign or malignant nature of a stricture 2

Comparison with ERCP

• MRCP has high sensitivity and specificity for detection of biliary and pancreatic duct pathologies, comparable to Endoscopic Retrograde Cholangiopancreatography (ERCP) 2, 3, 4, 6
• MRCP is more sensitive than ERCP in detection of pancreatic pseudocysts and is potentially more accurate in demonstrating the extent of biliary cystadenomas and cystadenocarcinomas 3
• No significant difference was found between MRCP and ERCP in diagnosing various pathologies such as choledocholithiasis, CBD dilation, CBD stricture, pancreatic duct dilatation, pancreatic duct stricture, and periampullary carcinoma 6

Advantages of MRCP

• MRCP is a non-invasive procedure, reducing the risk of complications associated with ERCP 2, 4
• It can be used to evaluate patients with suspected pancreaticobiliary disease, especially those with failed ERCP 2
• MRCP is accurate in detection of pancreas divisum and can demonstrate aberrant bile duct anatomy before cholecystectomy 3