VALUE OF MAGNETIC-RESONANCE CHOLANGIOPANCREATOGRAPHY (MRCP) AFTER UNSUCCESSFUL ENDOSCOPIC-RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP)

Background and Study Aims: The present study tries to evaluate the suc cess rate of MRCP when two attempts by experts to perform ERCP in a ce nter failed. Patients and Methods: From March 1996 to December 1996 th irteen patients fulfilled the inclusion criteria. The MR cholangiopanc reatograms were acquired using commercially available software in a cl inical MR scanner (Magnetom Expert 1 T-Scanner, Siemens, Erlangen, Ger many), MRCP utilized heavily T2-weighted turbo-spin echo sequences wit h fat supression (HASTE), Maximum intensity projection (MIP) of the pa ncreatic duct and biliary tree was then carried out. Additionally, T1- weighted sequences were obtained using the breath-hold technique. Resu lts: The MRCP images were of diagnostic quality in all 13 patients. In five cases the diagnoses detected by MRCP were followed by an interve ntional procedure. One patient showed a pancreatic pseudocyst, that wa s percutaneously drained using ultrasound guidance. In three cases we found benign bile duct obstruction, all of which were successfully tre ated by percutaneous transhepatic drainage. In one patient choledochol ithiasis was diagnosed, the stone was successfully managed by percutan eous transhepatic extraction. Conclusion: MRCP is the method of choice in cases where ERCP is incomplete or where duct cannulation is not po ssible. A further advantage of MR imaging is the fact that it may prov ide complementary information about the whole region of interest, thus detecting the cause of duct pathology in many cases.