Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.736
5-Year Impact Factor – 2.135
Index Copernicus  – 168.52
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2009, vol. 18, nr 3, May-June, p. 297–302

Publication type: original article

Language: English

Magnetic Resonance Cholangiopancreatography After Failed or Incomplete Endoscopic Retrograde Cholangiopancreatography

Zastosowanie cholangiopankreatografii rezonansu magnetycznego w przypadku nieudanej lub niekompletnej wstecznej endoskopowej cholangiopankreatografii

Tomasz Sozański1,, Violetta Sokolska2,, Krzysztof Moroń3,

1 Department of Pharmacology, Wroclaw Medical University, Poland

2 Department of General Radiology, Interventional Radiology and Neuroradiology, Chair of Radiology, Wroclaw Medical University, Poland

3 Department of Radiology, Wroclaw Medical University, Poland


Background. MRCP is a new noninvasive technique for examining the biliary and pancreatic ducts without the need for contrast medium and without any known side effects. MRCP could replace diagnostic ERCP and other invasive bile and pancreatic duct examination methods.
Objectives. Evaluation of the usefulness of MRCP to delineate bile and pancreatic ducts and depict pathological fluid collection in the biliopancreatic region in patients after failed or incomplete ERCP.
Material and Methods. MRCP was performed in 36 patients who had previously undergone an attempted ERCP. However, with ERCP complete duct visualization was obtained in only 17 patients, but it failed in 6 patients and opacification was incomplete in 13. MRCP was done using a 1.5−T Picker Edge Eclipse system (EXPRESS, TR: ∞, TEeff: 268 ms, ETL: 200, slice thickness: 50–70 mm, matrix: 336 × 512, FOV: 38 cm).
Results. Complete visualization of the ducts was obtained with MRCP in all 36 patients, whereas ERCP was successful in only 21 cases. In 6 patients, MRCP showed pseudocysts missed by ERCP. In 15 patients, no further invasive procedures were needed after MRCP.
Conclusion. MRCP is a valuable diagnostic tool for evaluating patients after failed or unsuccessful ERCP. MRCP is a noninvasive technique that may avoid the use of other, invasive procedures.


Wprowadzenie. MRCP jest nowoczesną, nieinwazyjną metodą diagnostyki dróg żółciowych i przewodu trzustkowego, która nie wymaga podania środków kontrastowych i nie daje powikłań. MRCP może zastąpić diagnostyczne ERCP i inne inwazyjne metody diagnostyki dróg żółciowych i przewodu trzustkowego.
Cel pracy. Ocena uwidocznienia dróg żółciowych i przewodów trzustkowych oraz patologicznych zbiorników płynowych w ich okolicy w badaniu MRCP u pacjentów po nieudanym lub niekompletnym ERCP.
Materiał i metody. Badanie MRCP wykonano u 36 pacjentów, u których wcześniej podjęto próbę wykonania ERCP, przy czym jedynie u 17 pacjentów (47,2%) w ERCP uzyskano pełny obraz badanych przewodów, u pozostałych 19 pacjentów bądź nie udało się wykonać ERCP (6 pacjentów), bądź jego obraz był niekompletny (13 chorych). Badania wykonano z użyciem aparatu Picker Edge Eclipse (sekwencje EXPRESS, TR – ∞, TEeff – 268 ms, ETL – 200, grubość warstw – 50–70 mm, matryca – 336 × 512, pole widzenia – 38 cm).
Wyniki. U wszystkich 36 pacjentów (100%) w MRCP uzyskano kompletny obraz badanych przewodów, podczas gdy w ERCP udało się to jedynie w 21 przypadkach. U 6 chorych w MRCP uwidoczniono pseudotorbiele, które nie były widoczne w ERCP. U 15 pacjentów na podstawie wyniku MRCP podjęto decyzję o niewykonywaniu dalszych inwazyjnych zabiegów.
Wnioski. MRCP jest skuteczną metodą diagnostyczną u pacjentów po nieudanym lub niekompletnym ERCP. MRCP jako metoda nieinwazyjna może zapobiegać wykonywaniu innych, inwazyjnych zabiegów.

Key words

MRCP, ERCP, bile ducts, pancreatic ducts

Słowa kluczowe

MRCP, ERCP, drogi żółciowe, przewody trzustkowe

References (28)

  1. Fulcher AS, Turner MA, Capps GW: MR Cholangiography: Technical Advances and Clinical Applications. RadioGraphics 1999, 19, 25–41.
  2. Fulcher AS, Turner MA: MR Pancreatography: A Useful Tool for Evaluating Pancreating Disorders. RadioGraphics 1999, 19, 5–24.
  3. Macdonald GA, Peduto AJ: Magnetic resonance imaging and diseases of the liver and biliary tract. Part 2. Magnetic resonance cholangiography and angiography and conclusions. J Gastroenterol Hepatol 2000, 15, 992–999.
  4. McCune WS, Sharp PE, Muscowitz M: Endoscopic cannulation of the ampulla of Vater: a preliminary report. Ann Surg 1968, 167, 752–755.
  5. Mercer S, Singh S, Paterson I: Selective MRCP in the management of suspected common bile duct stones. HPB (Oxford) 2007, 9 (2), 125–130.
  6. Binmoeller KF, Schafer TW: Endoscopic Management of Bile Duct Stones. J Clin Gastroenterol 2001, 32 (2), 106–118.
  7. Cohen SA, Siegel JH, Kasmin FE: Complications of diagnostic and therapeutic ERCP. Abdom Imaging 1996, 21, 385–394.
  8. Freeman ML, Nelson DB, Sherman S: Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996, 335, 909–918.
  9. Sheridan MB: Endoscopic retrograde cholangiopancreatography should no longer be used as a diagnostic test: the case in favour. Digest Liver Dis 2002, 34, 370–374.
  10. Baillie J: Training in advanced pancreaticobiliary endoscopy: why, how, and will we even need ERCP in the future? Tech Gastrointest Endosc 2004, 6, 100–106.
  11. Barish MA, Soto JA: MR cholangiopancreatography: techniques and clinical applications. AJR 1997, 169, 1295–1303.
  12. Bret PM, Reinhold C: Magnetic resonance cholangiopancreatography. Endoscopy 1997, 29, 472–486.
  13. Mitchell DG: MRI Principles. W.B. Saunders, Philadelphia 1999, 191–203.
  14. Masui T, Katayama M, Kobayashi S et al.: Magnetic resonance cholangiopancreatography: comparison of respiratory−triggered three−dimensional fast−recovery fast spin−echo with parallel imaging technique and breath−hold half−Fourier two−dimensional single−shot fast spin−echo technique. Radiat Med 2006 Apr, 24 (3), 202–209.
  15. Tang Y, Yamashita Y, Arakawa A: Pancreaticobiliary Ductal System: Value of HalfFourier Rapid Acquisition with Relaxation Enhancement MR Cholangiopancreatography for postoperative Evaluation. Radiology 2000, 215, 81–88.
  16. Reinhold C, Guibaud L, Genin G, Bret PM: MR cholangiopancreatography: comparison between two−dimensional fast spin−echo and three−dimensional gradient−echo pulse sequences. J Magn Reson Imaging 1995, 4, 379–384.
  17. Laubenberger J, Buchert M, Schneider B, Blum U, Hennig J, Langer M: Breath−hold projection magnetic resonance cholangiopancreatography (MRCP): a new method for the examination of the bile and pancreatic ducts. Magn Reson Med 1995, 33, 18–23
  18. Sai J, Ariyama J: MRCP Early Diagnosis of Pancreatobiliary Diseases. Springer−Verlag 2000, 11–62.
  19. Miyazaki T, Yamashita Y, Tsuchigame H, Urata J, Takahashi M: MR cholangiography using HASTE (halfFourier acquisition single−shot turbo spin−echo) sequences. AJR 1996, 166, 1297–1303.
  20. Sananes J, Lecesne R, Raymond J, Couzigou P, Laurent FH, Drouillard J: MR cholangiography with HASTE sequence: a new technique for noninvasive exploration of the biliary tract. Radiology 1995, 197 (P), 343.
  21. HosseinzadehK, Furlan A, Almusa O: 2D thick−slab MR cholangiopancreatography: does parallel imaging with sensitivity encoding improve image quality and duct visualization? AJR 2008 Jun, 190(6), W327–W334.
  22. Pamos S, Benages A, Medina E, Martinez Sanjuan V: Prospective evaluation of magnetic resonance cholangiopancreatography in patients with biliary disease: comparative study with conventional ultrasonography and endoscopic retrograde cholangiopancreatography. Dig Liver Dis 2003, 35, 186–192.
  23. Albert JG, Riemann JF: ERCP and MRCP – when and why. Best Pract Res Clin Gastroenterol 2002, 16 (3), 399–419.
  24. Sahni VA, Mortele KJ: Magnetic resonance cholangiopancreatography: current use and future applications. Clin Gastroenterol Hepatol 2008 Sep, 6 (9), 967–977.
  25. Soto JA, Yucel EK, Barish MA, Chuttani R, Ferrucci JT: MR cholangiopancreatography after unsuccessful or incomplete ERCP. Radiology 1996, 199, 91–98.
  26. Fulcher AS, Turner MA, Capps GW, Zfass AM, Baker KM: Half−Fourier RARE MRCP in 300 subjects. Radiology 1998, 207, 21–32.
  27. Reinhold C, Taourel P, Bret PM, Cortas GA, Mehta SN, Barkun AN, Wang L, Tafazoli F: Choledocholithiasis: Evaluation of MR Cholangiography for Diagnosis. Radiology 1998, 209, 435–442.
  28. Varghese JC, Farrell MA, Courtney G, Osborne H, Murray FE, Lee MJ: Role of MR cholangiopancreatography in patients with failed or inadequate ERCP. AJR 1999, 173, 1527–1533.