MAGNETIC RESONANCE-CHOLANGIOPANCREATOGRAPHY IN THE DIAGNOSIS OF BILIOPANCREATIC DISEASES

BACKGROUND: Magnetic resonance cholangiopancreatography (MRCP) is a ne w, noninvasive imaging technique for the visualization of the biliary ducts with cholangiographic images similar to those obtained with endo scopic retrograde cholangiopancreatography and percutaneous transhepat ic cholangiography. No contrast medium injection is used, The aim of t his study was to assess the feasibility of MRCP versus ERCP in the dia gnosis of biliary tract and pancreatic diseases.PATIENTS AND METHODS: One hundred and thirty-six patients were submitted to MRCP. They were referred to MR study according to four inclusion criteria: (1) evidenc e or suspicion of choledocholithiasis, (2) benign or malignant bile du cts,stenosis, (3) follow-up-of patients submitted to biliary-enteric a nastomosis, and (4) chronic pancreatitis with Wirsung duct dilatation. The MRCP was performed with a 0.5T superconducting magnet (Philips Gy roscan T5). When neoplastic disease was detected, additional images on axial planes were acquired. MRCP allowed images of diagnostic value t o be obtained in all the cases. RESULTS: In choledocholithiasis, MRCP showed 91.6% sensitivity, 100% specificity, and overall diagnostic acc uracy 96.8%. Of 48 patients with stenotic lesions, 16 were correctly c haracterized as benign and 30 as malignant. Two cases of focal chronic pancreatitis were misdiagnosed as pancreatic head carcinoma. In the p atients submitted to biliary-enteric anastomosis, MCRP was able to det ect the dilatation of the intrahepatic ducts, the stenosis, and associ ated stones in all 8 positive cases. In the remaining 7 patients with mild signs of cholangitis, MCRP showed irregular aspects of the biliar y tree in the main ducts. In the 11 patients with chronic pancreatitis , MCRP was able to depict the dilated Wirsung duct and the stenotic tr act, although the fine details of the secondary ducts were not evaluat ed due to the low spatial resolution as compared with conventional fil ms. CONCLUSIONS: MRCP can be considered a technique able to completely replace diagnostic ERCP. Further studies are necessary for a better e valuation of the potential advantages and disadvantages of this techni que. (C) 1997 by Excerpta Medica, Inc.