Magnetic resonance cholangiopancreatography

The Magnetic resonance cholangiopancreatography is a radiological examination method that generates diagnostic results for the field of internal medicine. It provides images of the ducts in the gallbladder and pancreas and can detect stone formation, inflammation or new tissue formation. Due to the non-invasive diagnosis and the absence of contrast media, the examination is very low-risk.

What is magnetic resonance cholangiopancreatography?

The MRCP or magnetic resonance cholangiopancreatography is a special examination that belongs to the field of radiology. In addition to the image material that a classic MRI provides of the upper abdominal organs, it can clearly show the duct system of the gallbladder and pancreas.

For this reason, the term cholangiopancreatography includes the terms bile (Cholé), pancreas (pancreas) and vessel (angio). It is the contrast medium-free and non-invasive alternative to endoscopic retrograde cholangiopancreatography (ERCP). As a special form of magnetic resonance imaging (MRI), it focuses on the representation of the bile ducts inside the liver and outside this organ and shows the main ducts of the pancreas.

Like the normal MRI of the abdomen, the magnetic resonance cholangiopancreatography is carried out in the magnetic resonance tomograph and is often ordered by the doctor as an additional examination to clarify certain questions. The MRCP may be necessary after an abnormal or unclear ultrasound examination (sonography) or it may be carried out at the same time as the MRI. Further examinations for the diagnosis of biliary and pancreatic ducts are the ERCP and the EUS, the endosonography, in which the ultrasound is carried out with the help of a small transducer from inside the body.

Function, effect & goals

With magnetic resonance cholangiopancreatography, the patient is driven into the tube like with classic magnetic resonance imaging and spends about 20 to 40 minutes there on a couch - depending on the question and examinations combined with the MRCP. There are different reasons for using this diagnostic method to map the duct system of the upper abdominal organs more precisely. The focus is on the presentation of gallstones, which may not or can only inadequately be detected with classic ultrasound.

However, if you are sure that there are gallstones that need to be removed, in most cases you will go the ERCP route: In contrast to the non-invasive MRCP, it offers the possibility of removing the disturbing stones from the bile duct system during the examination . Another area of ​​application of magnetic resonance cholangiopancreatography is the detection of inflammation in the area of ​​the pancreas, which is often difficult to assess using ultrasound. A third application for MRCP is to find cysts or tumors that can be benign or malignant. Here, too, the radiological examination method is usually superior to sonography. If the diagnosis of a bile duct tumor has already been established, ERCP will often be selected in this case too, in order to combine the diagnosis - if possible - with a surgical procedure.

In addition, the invasive examination method can also provide tissue samples for subsequent histological examination. If congenital anomalies in children, such as a malformation of the biliary tract, must be assessed in the painless and non-stressful MRCP. If a gastroscopy is scheduled, for example to clarify upper abdominal complaints, an ERCP can also be connected here, which renders magnetic resonance cholangiopancreatography unnecessary due to its unrestricted view of the ducts in the liver, gall bladder and pancreas. The advantages of MRCP are that it makes use of the high soft tissue contrast and the accumulation of fluid in the biliary and pancreatic ducts.

If necessary, it provides three-dimensional images that form a good basis for possible further therapy. If the pancreatic duct or an inflammatory disease of the biliary tract is to be shown within the scope of this examination procedure, a special drug is often given that enables an even clearer illustration of the duct system. A typical clinical picture that can be diagnosed in this way is PSC, the primary sclerosing cholangitis.

Risks, side effects & dangers

Magnetic resonance cholangiopancreatography is an examination method that has hardly any risks or side effects. The diagnosis in the magnetic resonance tomograph is - in comparison to the computer tomograph, for example - not associated with any X-rays, but generates meaningful cross-sectional images of the desired organs with the help of strong, but harmless magnetic fields.

Magnetism is also not a problem for examining children and pregnant patients. A contrast agent, which could possibly trigger an allergic reaction in the patient, does not have to be given in most cases for magnetic resonance cholangiopancreatography. In addition, the MRCP scores with the fact that it is non-invasive, so there are no complications from bleeding sources or the introduction of germs into the body in connection with a resulting infection. There are only a few restrictions on the group of people who can be examined with the MRCP.

Fearful patients who do not tolerate the tightness of the tube in the magnetic resonance tomograph have the option of using a so-called open MRI with much larger dimensions. Sedation of the patient is only possible to a limited extent, however, since the quality of the image recording in the MRCP requires the cooperation of the patient: You must lie absolutely still in the device and also be able to hold your breath for up to 40 seconds so that the Recordings can be made optimally. However, enormous advances have been made in the field of device technology, so that artifacts caused by movements of the examined patients can also be compensated to such an extent that the desired image quality can still be achieved.