Bilio-pancreatic anomalies obscured with MRCP

In this article the authors discuss whether or not diagnostic potential of MR cholangiopancreatography is strong enough to replace direct cholangiography in all cases. The pre-surgery analysis of a variety of pancreato-biliary disorders diagnosed using MRCP images is presented with the emphasising the importance of source images. Six cases of pancreato-biliary disorders are presented in which MRCP indicated the place of ductal stenosis as well as the morphologic variants or ductal uninspected shape which is critical for surgery or planned drainage. Coronal and axial MRCP source and MIP images were obtained with 0.5 T Gyroscan NT. Anomalies of the biliary or pancreatic ducts included two cases of choledochal cystic dilatation; two cases of aberrant biliary ducts, one case of gallbladder duct variant and a case of an additional pancreatic duct. In 3 out of 6 cases, the MRCP source images produced using the complementary method supplied more complete information concerning ductal junctions than the MIP images. Whereas in 3 out of 6 cases, both kinds of images were equally reliable. In 4 out of 6 cases, endoscopy was performed, and in 2 cases ERCP images were not diagnostic for ductal anatomy. However, full delineation of biliary and pancreatic ducts was complete in all MRCP images. MRCP within source images and maximum intensity projections show particular promise for the assessment of pancreato-biliary anomalies in order to reduce the number of higher-risk endoscopic interventions. The technique should be the method of choice in cases of suspected pancreato-biliary anomaly resulting from any imaging modality and is helpful for planning the optimal drainage method. In the long run this practice would reduce the number of ducts damaged during surgery.