Magnetic Resonance Cholangiopancreatography - MRCP

Magnetic resonance cholangiopancreatography (MRCP) is a well established non-invasive imaging modality that produces images of the pancreatic duct and biliary tree without the need for intravenous contrast.

The images are equivalent to those from endoscopic retrograde cholangiopancreatography (ERCP).

MRCP's most common indications are patients with a suspicion of choledocholithiasis. Other indications include diagnosis of Primary Sclerosing Cholangitis (PSC), biliary strictures(post surgical, neoplastic or inflammatory) or delineation of anatomy prior to surgery/ERCP.

MRCP also has a role in unusual conditions such as oriental cholangiohepatitis , annular pancreas , ampullary tumours , choledochal cysts , Carolis disease and autosomal dominant polycystic liver disease.

The advantages of the technique include its non-invasiveness, the absence of contrast administration, its relative operator independence and the ability to evaluate both sides of an obstructed duct, thereby accurately evaluating stricture morphology and length.

Clinical scenarios for which MRCP is being widely used in Christchurch include:

i)	Patients who have had a prior cholecystectomy and now have right upper quadrant pain, and obstructive liver function tests. An ultrasound in this situation is useful to measure the size of the duct but not to exclude a calculus.
ii)	Patients presenting with obstructive jaundice and dilated common bile duct on ultrasound. In these patients the cause of the extra hepatic obstruction eg: calculus or carcinoma of head of pancreas is assessed. Extra scan sequences can be added to show the entire pancreas.
iii)	Prior to laproscopic cholecystectomy to ensure there is no calculus in the common bile duct. It is worth noting that a normal sized common bile duct on ultrasound does not exclude a bile duct calculus.
iv)	Patients with abnormal liver function tests and high clinical suspicion of PSC. i.e. Inflammatory Bowel Disease

This procedure is available at St Georges Radiology and Southern Cross Radiology using a 1.5 Tesla Magnet and at Hagley Radiology using a 3 Tesla Magnet ( which offers 40% better resolution helpful for detection of PSC ) and takes between 20 and 30 minutes. It is suitable for all age groups and is very useful in the elderly. The cost is $826

Dr Wayne Bailey ( MBChb , RANZCR. ) 
Gastro-Intestinal and Abdominal Radiologist 
CHRISTCHURCH RADIOLOGY GROUP

 

MRCP CASES ARE SHOWN BELOW.

1. Normal.
   
   
2. Choledocholithiasis.
   
   
3. Klatskin Tumour.
   
   
4. PSC.
   
   
5. Carolis disease.
   
   
6. Pancreas divism.
   
   
7. Intraductal Papillary Mucinous Neoplasm
   
   
8. Polycystic liver disease.