Value of magnetic-resonance cholangio-pancreatography (MRCP) after unsuccessful endoscopic-retrograde cholangio-pancreatography (ERCP).

Background And Study Aims: The present study tries to evaluate the success rate of MRCP when two attempts by experts to perform ERCP in a center failed.

Patients And Methods: From March 1996 to December 1996 thirteen patients fulfilled the inclusion criteria. The MR cholangiopancreatograms were acquired using commercially available software in a clinical MR scanner (Magnetom Expert 1 T-Scanner, Siemens, Erlangen, Germany). MRCP utilized heavily T2-weighted turbo-spin echo sequences with fat supression (HASTE). Maximum intensity projection (MIP) of the pancreatic duct and biliary tree was then carried out. Additionally, T1-weighted sequences were obtained using the breath-hold technique.

Results: The MRCP images were of diagnostic quality in all 13 patients. In five cases the diagnoses detected by MRCP were followed by an interventional procedure. One patient showed a pancreatic pseudocyst, that was percutaneously drained using ultrasound guidance. In three cases we found benign bile duct obstruction, all of which were successfully treated by percutaneous transhepatic drainage. In one patient choledocholithiasis was diagnosed, the stone was successfully managed by percutaneous transhepatic extraction.

Conclusion: MRCP is the method of choice in cases where ERCP is incomplete or where duct cannulation is not possible. A further advantage of MR imaging is the fact that it may provide complementary information about the whole region of interest, thus detecting the cause of duct pathology in many cases.