MR-cholangiopancreaticography (MRCP) and MR-angiography: morphologic changes with magnetic resonance imaging

Since 1997 we have prospectively tried to assess/confirm the diagnostic value of MR-Cholangiopancreaticography (MRCP) and MR-Angiography in patients suffering from pancreatic carcinoma. Till today we have studied 116 adult patients with two 1,5 Tesla MRT scanners using a body phased-array coil: 27 patients with benign diseases of the pancreas, 58 with carcinoma of the pancreas, 15 with no disorder of the pancreatobiliary system, 14 with hepatic abnormalities and 2 with other tumors. MR examinations included routinely T1-weighted (TSE, SE), T1-weighted fat-suppressed (TSE, SE), T2 weighted fast turbo spin-echo (UTSE, Haste), T2-weighted fat-suppressed fast turbo spin-echo (SPIR), 2D-cholangiopancreaticography (images were obtained with breath-held) or 3D-cholangiopancreaticography (images were obtained in coronal and axial plane with respiratory triggering). In cases with pancreatic cancer we added MR-angiography. MR images were retrospectively compared with CT, ERCP amd sonography data. Summarizing the results confirm that MRCP is a safe and non-invasive technique for studying pancreatic and biliary diseases which yields information in many cases complemontory to ERCP and PTC. MRCP images can also be used as a guide for subsequent interventional procedures. MRCP will, therefore, allow the restriction of ERCP and PTC to more therapeutical indications and cases offering special problems. Considering staging and follow-up of pancreatic cancer, MRCP cross-sectional images and MR-angiography should be performed, allowing the visualization of the extraductal anatomy/pathology. These techniques may provide the clinicians with complementary information compared to other conventional imaging methods like US and CT. Clinicians engaged in pancreatic oncology, therefore, should have MRCP, MR-angiography and MR imaging available in addition to the conventional diagnostic tools.