What is the role of magnetic resonance cholangiopancreatography (MRCP) in the evaluation of biliary obstruction?

Updated: Oct 16, 2019
  • Author: Jennifer Lynn Bonheur, MD; Chief Editor: Vinay Kumar Kapoor, MBBS, MS, FRCS, FAMS  more...
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Note the following:

  • As with helical CT scanning, MRCP gives radiologists the ability to analyze source images and 2- and 3-dimensional projections. Although some techniques require patients to hold their breath for the highest quality images, the time required to complete the scan is decreasing as imaging techniques improve, and alternative procedures capture images between patient breaths.

  • MRCP provides a sensitive noninvasive method of detecting biliary and pancreatic duct stones, strictures, or dilatations within the biliary system. It is also sensitive for helping detect cancer. MRCP combined with conventional MR imaging of the abdomen can also provide information about the surrounding structures (eg, pseudocysts, masses).

  • While ERCP and MRCP may be similarly effective in detecting malignant hilar and perihilar obstruction, MRCP has been shown to be better able to determine the extent and type of tumor as compared to ERCP. In addition, unlike ERCP, MRCP does not require contrast material to be injected to visualize the ductal system, thereby avoiding the morbidity associated with injected contrast.

  • The limitations of MRCP include the contraindications to magnetic resonance imaging. Absolute contraindications include the presence of a cardiac pacemaker, cerebral aneurysm clips, ocular or cochlear implants, and ocular foreign bodies. Relative contraindications include the presence of cardiac prosthetic valves, neurostimulators, metal prostheses, and penile implants.

  • Fluid stasis in the adjacent duodenum or in ascitic fluid may produce image artifacts on MRCP, making it difficult to clearly visualize the biliary tree.

  • The risk of MRCP during pregnancy is not known.

  • Although MRCP currently does not have the capability for the therapeutic applications of the more invasive ERCP, it can be useful for diagnostic purposes and poses less risk to the patient as compared to ERCP.

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