A comparison of Magnetic Resonance Cholangiopancreatography (MRCP) and ERCP in the evaluation of chronic pancreatitis

Introduction: Magnetic Resonance Cholangiopancreatography (MRCP) is a novel application of MRI which may replace diagnostic ERCP in many cases. The indications for and diagnostic yield of MRCP remain to be elucidated. We performed a comparison of MRCP and ERCP in 9 cases of chronic pancreatitis. Methods: Both ERCP and MRCP were performed within a 24 hour period on 9 patients, 5 female, 4 male, median age 57 years. MRCP was performed on a 1.5 Tesla GE scanner using a phased array surface coil and respiratory gating. Axial and coronal T2 weighted flow compensated spin echo sequences with 4mm slices were used to image the pancreas, liver and bile ducts. A T1 weighted axial sequence of the pancreas was also obtained. Maximum intensity projection 3D reconstructions were then made of the pancreatic duct (PD) and biliary tree. No therapeutic procedures were performed at ERCP. The MRCP was read by two radiologists and the results compared with the ERCP films. Results: The MRCP images were of diagnostic quality in all 9 patients. At ERCP a pancreatogram was obtained in all 9 patients and a cholangiogram in 8. In the patient in whom a cholangiogram could not be obtained at ERCP, MRCP demonstrated a dilated biliary tree. In the same patient, ERCP revealed a PD cutoff while MRCP defined a common bile duct stricture and visualized the dilated PD upstream from (proximal to) the stricture. Finally, PD calculi not seen at ERCP were detected in 2 cases by MRCP. Pancreatic duct abnormalities including side branch changes were detected by MRCP in all 9 cases. Conclusion: MRCP compares well with ERCP in assessing the pancreatic duct. In our series, MRCP successfully demonstrated all clinically significant abnormalities seen on ERCP. MRCP may provide complementary information to ERCP such as PD calculi and pancreatic ductal anatomy proximal to the site of an obstruction.

Duke Scholars

Author Paul Simon Jowell Medicine, Gastroenterology

Author Rendon C. Nelson Radiology

Author Charles Edward Spritzer Radiology, Musculoskeletal Imaging

Author Malcolm Stanley Branch Medicine, Gastroenterology