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Updated: Jun 16, 2026
DUCT: Double Resin Casting followed by Micro-Computed Tomography for 3D Liver Analysis
Published on: September 28, 2021
Image quality and bile duct volumetry in MR cholangiopancreatography augmented with low-dose morphine
Patric Kröpil1, Andreas Erhardt, Silke Mehnert
1Department of Radiology, University Hospital Düsseldorf, Germany.
Objective:
Opioids are applied to augment visualization of the biliary system in MR cholangiopancreatography (MRCP) to take advantage of a side effect, the constriction of the sphincter of Oddi. This prospective study was performed to determine the effect of IV low-dose morphine on image quality and bile duct delineation in MRCP.
Subjects And Methods:
Fifteen healthy volunteers and 15 consecutive patients underwent MRCP on a 1.5-T MRI scanner. Strongly T2-weighted 3D single-shot fast spin-echo (SSFSE) sequences were acquired before and 10 minutes after IV administration of morphine (0.04 mg/kg of body weight; mean +/- SD, 2.9 +/- 0.5 mg). Maximum intensity projections were reconstructed from the SSFSE sequence data. Image quality was rated by two independent radiologists using a 4-point scale (1 = excellent, 4 = not diagnostic). Delineation of segmental and subsegmental intrahepatic bile duct orders before and after morphine administration was compared. Volumetry of the common bile duct (CBD) was performed using electronic measurements (AngioTux software, ECCET image processing system).
Results:
IV morphine did not significantly improve subjective image quality of the extra- and intrahepatic bile ducts (mean image quality score before vs after morphine administration, 2.3 vs 2.0) or delineation of the intrahepatic bile duct orders. The volume of the CBD remained constant after morphine administration (mean CBD volume before vs after morphine administration, 14.1 vs 13.6 mL). Notable side effects of morphine were seen in two young healthy female volunteers.
Conclusion:
IV-administered low-dose morphine seems to have no essential influence on image quality or delineation of the bile duct system in MRCP. Therefore, the general advice to perform morphine-augmented MRCP should be discussed critically.
Insights
Low-dose intravenous morphine did not improve magnetic resonance cholangiopancreatography (MRCP) image quality or bile duct visualization in patients. The study suggests reconsidering the routine use of morphine for MRCP procedures.
Area of Science:
- Radiology
- Medical Imaging
- Gastroenterology
Background:
- Opioids are sometimes used to enhance visualization of the biliary system during Magnetic Resonance Cholangiopancreatography (MRCP).
- This technique leverages the sphincter of Oddi constriction effect of opioids.
- The efficacy of low-dose morphine for MRCP remains to be critically evaluated.
Purpose of the Study:
- To prospectively assess the impact of intravenous low-dose morphine on MRCP image quality.
- To determine the effect of morphine on the delineation of bile ducts in MRCP.
- To evaluate changes in common bile duct (CBD) volume following morphine administration.
Main Methods:
- Fifteen healthy volunteers and 15 patients underwent 1.5-T MRCP.
- T2-weighted 3D SSFSE sequences were acquired before and after IV morphine (0.04 mg/kg).
- Image quality was rated, bile duct delineation assessed, and CBD volumetry performed.
Main Results:
- Intravenous morphine did not significantly enhance subjective image quality of the bile ducts (mean score 2.3 vs 2.0).
- No significant improvement in intrahepatic bile duct delineation was observed.
- Common bile duct volume remained stable post-morphine administration (14.1 vs 13.6 mL).
- Two volunteers experienced mild side effects.
Conclusions:
- Low-dose intravenous morphine administration has no significant effect on MRCP image quality or bile duct delineation.
- The routine recommendation for morphine-augmented MRCP warrants critical discussion.
- Further research may be needed to explore alternative methods for MRCP enhancement.
