Learning objectives: To describe and correlate magnetic resonance cholangiopancreatography (MRCP) findings with subsequent endoscopic retrograde cholangiopancreatography (ERCP) findings in cases reviewed over the past year in a hepatopancreatobilliary (HPB) weekly meeting in a tertiary referral centre.


Background: MRCP is the primary, non-invasive, diagnostic imaging technique performed to visualise the pancreaticobiliary ductal system. It uses heavily T2-weighted pulse sequences to exploit the intrinsic T2-weighted relaxation times of slow-flowing or stationary fluid in biliary structures. One advantage is the depiction of extrabiliary ductal system pathology. Imaging during ERCP is performed under fluoroscopy while iodinated contrast medium is injected into the biliary system. Both diagnostic and therapeutic intervention can be performed and major procedure-related complications include cholangitis and pancreatitis.


Imaging findings OR Procedure findings: Patients undergoing MRCPs over a 12 month period and having subsequent ERCP were included. Indications for MRCP varied and included deranged liver function tests, right upper quadrant pain, jaundice, pancreatitis, and lithiasis. We correlated our imaging findings with findings on ERCP, assessing our accuracy, and necessity for ERCP.

Benign pathologies included cholelithiasis, choledocholithisis, non malignant strictures, cholangitis, cholecystitis and pancreatitis. Malignant findings included cholangiocarcinoma, pancreatic carcinoma, lymphadenopathy from cancer of unknown primary.

MRCP yielded more information than ERCP in cases of ERCP failure due to non-malignant strictures, patient anatomy (roux-en-y), or in extra-ductal findings such as hepatic metastases as anticipated.


Conclusion:We demonstrate a variety of ductal and extra-ductal findings on MR, in patients undergoing MRCP for a range of indications, compared with ERCP findings.

MRCP with follow-on ERCP - correlating imaging findings with ERCP results