Magnetic resonance cholangiopancreatography is a radiological examination method that generates diagnostic results in the field of internal medicine. It provides footage of the gallbladder and pancreas galleries and can detect calculus, inflammation or neoplasm of tissue. Due to the non-invasive diagnostics and the lack of contrast agents, the examination is very low in risk.

What is Magnetic Resonance Cholangiopancreatography?

The MRCP provides images of the gallbladder and pancreas ducts and can detect calcifications, inflammations or neoplasms of tissue.

MRCP or Magnetic Resonance Cholangiopancreatography is a special examination that belongs to the Department of Radiology. Beyond the imagery that a classic MRI provides from the upper abdominal organs, it can clearly visualize the duct system of the gallbladder and pancreas.

For this reason, in the term Cholangiopankreatikographie put the names bile (Cholé), pancreas (pancreas) and vessel (Angio). It is the contrast-free and non-invasive alternative to endoscopic retrograde cholangiopancreatography (ERCP). As a special form of magnetic resonance imaging (MRI), it focuses on the visualization of the bile ducts within the liver and outside of this organ and depicts the major pancreatic ducts.

Like the normal MRI of the abdomen, magnetic resonance cholangiopancreatography is performed in the magnetic resonance tomograph and is often ordered by the doctor to clarify certain questions as an additional examination. The MRCP can be performed after a conspicuous or unclear ultrasound (sonography) necessary or simultaneously with the MRI. Further examinations for the diagnosis of biliary and pancreatic ducts are the ERCP and the EUS, the endosonography, in which the ultrasound is carried out from the inside of the body with the help of a small transducer.

Function, effect & goals

In magnetic resonance cholangiopancreatography, the patient is driven into the tube as in the classical nuclear spin and spends about 20 to 40 minutes there on a couch - depending on the research question and MRCP combined examinations. There are different reasons for using this diagnostic method to more accurately map the ductwork of the upper abdominal organs. The focus is on the presentation of gallstones, which may not be detected with conventional ultrasound, or only inadequately.

However, if you are sure that you have gallstones to remove, you will most likely be on the ERCP path: unlike non-invasive MRCPs, it allows you to remove the interfering stones from the bile duct system during the exam, Another field of application of magnetic resonance cholangiopancreatography is the detection of pancreatic inflammation, which is often difficult to assess by ultrasound. A third use for MRCP is finding cysts or tumors that may be benign or malignant. Again, the radiographic examination method of sonography is usually superior. If the diagnosis of a bile duct tumor is already known beforehand, one will often choose the ERCP in this case, in order to connect the diagnosis - if possible - immediately with an operative intervention.

In addition, the invasive examination method can also yield tissue samples for subsequent histological examination. If children have congenital anomalies, such as a malformation of the biliary tract, this can be assessed in the pain-free and non-burdensome MRCP. If, for example, for the diagnosis of epigastric discomfort - a gastroscopy is scheduled, here also an ERCP can be connected, which makes the magnetic resonance cholangiopancreatography unnecessary because of their unrestricted view of the passages in the liver, bile and pancreas. The advantages of MRCP are that it benefits from the high soft tissue contrast and fluid accumulation of biliary and pancreatic ducts.

If necessary, it provides three-dimensional images that provide a good basis for possible further therapy. If a pancreatic duct or an inflammatory disease of the bile ducts is to be visualized in the course of this examination procedure, a special drug is often given which allows an even clearer picture of the ductwork. A typical clinical picture that can be diagnosed in this way is PSC, the primary sclerosing cholangitis.

Risks, side effects & dangers

Magnetic resonance cholangiopancreatography is a method of investigation that brings little risk or side effects. Diagnostics in MRI scanners are not connected to any X-ray radiation, for example compared to computed tomography scanners, but produce meaningful cross-sectional images of the desired organs using strong, but harmless, magnetic fields.

Magnetism is also no problem for the examination of children and pregnant women. Also, a contrast agent, which could possibly trigger an allergic reaction in the patient, in most cases does not have to be given in magnetic resonance cholangiopancreatography. In addition, the MRCP scores with the fact that it is not invasive, so there is no need to fear complications from the sources of bleeding or the introduction of germs into the body in conjunction with the resulting infection. There are only a few restrictions for the group of people who can be examined with the MRCP.

Feared patients, who do not tolerate the narrowness of the tube in the magnetic resonance tomograph, have the opportunity to use a so-called open MRI with much larger dimensions. However, patients can only be sedated to a limited extent because the quality of the MRCP image acquisition requires the cooperation of the patients: they must be absolutely still in the device and be able to hold their breath for up to 40 seconds, so that the patient can Recordings can be made optimally. However, enormous advances have been made in the field of device technology, so that even artifacts can be compensated by movements of the examined patients to the extent that the desired image quality can still be achieved.

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