MR cholangiopancreatography of bile and pancreatic duct abnormalities with emphasis on the single-shot fast spin-echo technique.

Vitellas KM, Keogan MT, Spritzer CE, Nelson RC.
Department of Radiology, Ohio State University Medical Center, Columbus, OH 43210, USA.

Radiographics. 2000 Jul-Aug;20(4):939-57; quiz 1107-8, 1112

Magnetic resonance cholangiopancreatography (MRCP) is used for noninvasive work-up of patients with pancreaticobiliary disease. MRCP is comparable with invasive endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis of extrahepatic bile duct abnormalities. In patients with choledocholithiasis, calculi appear as dark filling defects within the high-signal-intensity fluid at MRCP. Benign strictures due to sclerosing cholangitis are multifocal and alternate with slight dilatation or normal-caliber bile ducts, producing a beaded appearance. Dilatation of both the pancreatic and bile ducts at MRCP is highly suggestive of a pancreatic head malignancy. Side-branch ectasia is the most prominent and specific feature of chronic pancreatitis. MRCP is more sensitive than ERCP in detection of pancreatic pseudocysts because less than 50% of pseudocysts fill with contrast material. Because the mucin secreted by biliary cystadenomas and cystadenocarcinomas causes filling defects and partial obstruction of contrast material at ERCP, MRCP is potentially more accurate in demonstrating the extent of these tumors. In patients with biliary-enteric anastomoses, MRCP is the imaging modality of choice for the work-up of suspected pancreaticobiliary disease. A potential use of MRCP is the demonstration of aberrant bile duct anatomy before cholecystectomy. MRCP is also accurate in detection of pancreas divisum.

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