Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive MRI technique used to visualize the biliary and pancreatic ducts. It utilizes heavily T2-weighted sequences to provide high signal from fluid-filled structures like the biliary tree and pancreatic ducts. MRCP has largely replaced diagnostic ERCP as it is less invasive and avoids risks of radiation exposure. It is useful for evaluating biliary diseases like cysts, stones, strictures, and pancreatic conditions such as divisum and cancer. With refinements in techniques such as secretin administration, MRCP provides accurate assessment of pancreaticobiliary anatomy and pathology in a safe, noninvasive manner.

1. Magnetic Resonance
Cholangiopancreatography
(MRCP)

4. Introduction
Introduced in 1991.
Magnetic resonance cholangiopancreatography
(MRCP) is performed with heavily T2-weighted fast
spin-echo sequences.
Noninvasive, less costly, and sensitive alternative to
diagnostic ERCP

5. It is a MRI technique used to investigate Biliary
and Pancreatic pathologies.
It makes use of heavily T2-weighted pulse
sequences, thus exploiting the inherent
differences in the T2-weighted contrast between
stationary fluid-filled structures in the abdomen
(which have a long T2 relaxation time) and
adjacent soft tissue (which has a much shorter T2
relaxation time).
Static or slow moving fluids within the biliary tree
and pancreatic duct appear of high signal
intensity on MRCP, whilst surrounding tissue is of
reduced signal intensity.
Introduction

6. PATIENT PREPARATION
• It is very crucial to optimize imaging of the biliary system with MRCP.
• The patient fasts for 4 hours to help reduce peristalsis and gastroduodenal
fluid before imaging.
• Oral contrast material that lowers the signal intensity of intraluminal fluid
in the bowel on T2-weighted images.
• Superparamagnetic iron oxide particles, gadolinium- meglumine
compounds or pineapple juice administered to suppress the signal from
fluid in the gastrointestinal tract.
• Patient removes all external metal items prior to entering the magnet, and
is given ear plugs.

8. TECHNIQUE
Patients are fasted for 4 – 6 hrs prior to the study in order to reduce
fluid secretions within the stomach and duodenum, reduce bowel
peristalsis and promote gallbladder distension.
A negative oral contrast agent (e.g. iron oxide or Blueberry or
Pineapple juice) to reduce the signal intensity of overlapping fluid
within the stomach and duodenum.
A phased array body coil is used.
Modified Fast Spin Echo (FSE) sequences like Rapid Acquisition with
Rapid Enhancement sequence (RARE) and Half Fourier acquisition
single shot turbo spin echo (HASTE) are ideally used in combination
for MRCP which takes only 10 minutes of imaging time while providing
improved quality of image

9. First an axial 2D breath-hold HASTE sequence is taken. Two breath-hold
acquisitions are obtained, so that the whole of the liver down to the
duodenal ampulla is visualized.
Following this, two 3D respiratory-triggered heavily T2-weighted
FSE sequences in the coronal oblique plane are taken.
Around 40-45 slices are obtained, which are contiguous and each of 1.5 mm in
thickness. As the images are heavily T2-weighted, the pancreatico-biliary tree
is displayed as high signal intensity, whilst adjacent structures are of reduced
signal intensity.
A thick collimation slab can be obtained in the coronal plane involving a
fat saturated HASTE sequence where a single slab of data 4 cm in thickness is
acquired in a 1- to 2-s breath-hold. It is useful in depicting the entire
pancreatico-biliary tree and no post- processing is required.
In order to evaluate the duct walls, and any focal parenchymal pathology, 3D
fat suppressed T1-weighted GRE sequences are taken.

10. IMAGING PARAMETERS

11. APPLICATIONS
• BILIARY DISEASE
- Cystic disease of bile ducts (choledochal
cyst, choledochocele, caroli’s disease)
- Congenital variants (aberrant right hepatic artery, low
or medial duct insertion).
- Choledocholithiasis
- Primary sclerosing cholangitis
- Post surgical biliary complications
- Cholangiocarcinoma

12. APPLICATIONS
• PANCREATIC DISEASE
- Pancreatic divisum
- Chronic pancreatitis
- Ca pancreas

13. APPLICATIONS
• In choledochal cysts :
- MRCP is equivalent to ERCP.
-detects the presence of anomalous union of
pancreatic & bile ducts.
-the length of extrahepatic bile duct involved by the
cyst is known – an important consideration in
planning surgery.
- well suited for pediatric patients.

17. Secretin-stimulated MRCP
Secretin is an endogenous hormone normally produced by the
duodenum, which stimulates exocrine secretion of the pancreas.
When given as a synthetic agent intravenously (1 ml/10 kg body
weight), it improves the visualisation of the pancreatic duct by
increasing its calibre.
Its effect starts almost immediately and peaks between 2 to 5 mins.
By 10 min, the calibre of the main pancreatic duct should return to
baseline with persistent dilatation of >3 mm considered abnormal.
The indications for this technique include the detection and
characterisation of pancreatic ductal anomalies and strictures,
evaluation of the integrity of the pancreatic duct, characterisation of
any communication between the pancreatic duct and
pseudocysts/pancreatic fistulas, and the assessment of pancreatic
function and sphincter of Oddi dysfunction.

18. Functional MR cholangiography
This involves the use of MR lipophilic paramagnetic contrast agents, which when
given intravenously, show hepato-biliary excretion. Contrast agents include
gadobenate dimeglumine , gadolinium ethoxybenzyldiethylenetriamine penta-acetic
acid and mangafodopir trisodium.
Delayed imaging in the axial and coronal plane, performed between 10-120 min
following intravenous administration, normally results in hyper-intense bile on
3D T1-weighted fat- saturated GRE images.
Advantages : (1) it better demonstrates communications between cystic lesions and
draining bile ducts in the diagnosis of congenital biliary disorders (e.g. Caroli’s
disease) (2) it helps to distinguish true obstruction in a dilated biliary system (where
delayed or no biliary excretion is demonstrated) from pseudo-obstruction and
(3) it can demonstrate active extravasation of contrast in suspected bile
leaks.

19. Pitfalls on MRCP
Artefacts related to technique and reconstruction.
Normal variants mimicking pathology.
Intra-ductal factors.
Extra-ductal factors.

20. INDICATIONS
Biliary Disease
• Cystic disease of bile duct (choledochal cystcholedochocele,
Caroli’s disease)
• Congenital variants (low or medial duct insertion, aberrant
right hepatic duct)
• Choledocholilithiasis
• Primary sclerosing cholangitis
• Post-surgical biliary complications
• Cholangiocarcinoma
Pancreatic Disease
• Pancreas divisum
• Chronic pancreatitis
• Pancreatic cancer

21. CHOLEDOCHAL CYST

22. Caroli’s disease

23. Choledocholilithiasis

24. Primary Sclerosing Cholangitis

25. Post-surgical biliary complications

26. Cholangiocarcinoma

27. Pancreas divisum

28. MRCP vs ERCP
Magnetic Resonance Choloangiopancreatography (MRCP)
is a relatively newer, non- invasive, radiation free
modality for visualization of biliary system. It is mainly
useful in patients with contraindication to invasive
modality like Endoscopic Retrograde
Choloangiopancreatography (ERCP) .

29. SUMMARY
• Over the past decade, MRCP has evolved not only as
a feasible means of non-invasively evaluating the
pancreatobiliary tract but also as a technique with
documented clinical utility.
• In fact, at some institutions MRCP has replaced
diagnostic ERCP such that ERCP is preserved for
only therapeutic interventions.
• MRCP + abd MR + MRA – evaluates solid organs&
vessels of abd & ductal systems

30. REFEREN
CES
• Hemant T. Patel, Ankur J. Shah, Shikha
R. Khandelwal, Hiren F. Patel, Megha
D. Patel:
MR Cholangiopancreatography at
3.0 T. RadioGraphics 2009;
29:1689–1706 .
• Computed body tomography with
MRI correlation-Lee & Sagel.

31. Thank You
Nitish Virmani
Lecturer
Department of Radio-Imaging Technology
Faculty of Allied Health Sciences
SGT University
Email- nitishvirmani18@gmail.com