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home - Liver - Liver Imaging - Liver Imaging MRCP Written by Dr Sebastian Zeki

Liver Imaging MRCP

Written by Dr Sebastian Zeki MRCP- Clinical Uses Pancreatitis and pancreatic cancerAcute pancreatitis can detect HPB stones/ pancreatic cysts/pancreas divisum.MRCP= ERCP for pancreatic cancer vs chronic pancreatitis.Se for pancreatic ca = 84 , sp= 97 %.Secretin-enhancement can assess pancreatic exocrine function and in the early diagnosis of chronic pancreatitis it is not used for imaging bile ducts. Acute cholecystitisMRCP > USS for cystic duct stones (sensitivity 100 vs 14 %).USS> MRCP for gallbladder wall thickening (sensitivity 69 vs 96 %). Common duct stonesMRCP=ERCP for sensitivity and specificity of CBD stones (sensitivity drops with dilated duct).In the presence of a dilated CBD, MRCP has a 90-95 % concordance with ERCP in diagnosing CBD stones> 4 mm in diameter.Stones> 4 mm can’t be differentiated from filling defects such as blood clots, tumor, sludge, or parasites.Other mimickers of choledocholithiasis include flow artifacts, biliary air, and a pseudostone at the ampulla. Patients with known or sus-pected PSCMRCP + routine MR is useful to see segmental extent of ductal involve-ment to help plan for surgery, search for intrahepatic metastases, and identify aberrant ductal anatomy.MRCP< ERCP for subtle peripheral duct changes or wall abnormalities as ducts not distended. Malignant hilar and perihilar obstructionMRCP can delineate anatomical extent of perihilar obstruction and aetiology. CholangiocarcinomaThe role of MRCP is unde-fined. Bile duct obstructionMRCP identifies larger intra and extrahepatic ducts in 95% with normal caliber ducts.MRCP Se 95% and sp 97% for dx of biliary obstruction.Se lower for stones (92 %) and malignancy (88 %). TechniqueAll images are T2 weighted scans; then volume rendered to depict intra- and extrahepatic bile ducts.Limitations include image artifacts and patient compliance.MRCP is lower resolution than ERCP- can miss small stones (<4 mm) in CBD and pancreatic duct, small ampullary lesions, PSC, and strictures of the ducts.In addition, certain anatomic characteristics or disorders can mimic bile duct obstruction or CBD stones.Obstructing stones are easier to identify than nonobstructing (especially if smaller than the thickness of the acquired image slices).

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