GI Series: MRCP scan test procedure explained

What is MRCP scan

The MRCP test, stands for Magnetic resonance cholangiopancreatography (mrcp), is a diagnostic imaging procedure that evaluates the biliary and pancreatic ducts, gallbladder, and pancreas. It is usually done when there are symptoms of biliary and pancreatic origin. 



MRCP uses magnetic resonance imaging to examine the bile ducts and pancreas. The test is done in an MRI machine. A substance called gadolinium (a contrast agent) will be injected into the person's bloodstream before the exam to help make certain parts of the body easier to see on images.

How the procedure is performed

The scan is typically done in an outpatient setting. The patient will then lie on their side or stomach while images are taken of the liver, pancreas, and bile ducts.

This is a noninvasive test and doesn't require ionizing radiation. Though you need to inform in prior about any metal implants or electromagnetic device you wear e.g.  joint replacements, metallic heart valves or pacemakers.

What is the preparation for MRCP test procedure?

You might be asked to stop eating and drinking a few hours before the procedure and wear loose fitting clothes and remove any devices, rings or credit/debit cards (that contain magnetic strip).

The test involves lying on a table that slides into a tube shaped structure which contains circular magnets. As the MRI scan can take several minutes, unlike the CT scan, people with claustrophobia may find it uncomfortable and may need sedation.

In addition, you might provide also need to provide any information about any previous contrast related reaction, if any.

How much time MRCP test takes?

MRCP test takes around 15 minutes but if abdomen is done along with it might take 30-45 minutes, in addition, you might be given a contrast injection through your veins.

How MRCP works

The MRCP doesn't use any radiation, e.g. x-rays, it utilizes magnetic waves produced by the rotating magnet inside the scanner, which causes alignment of hydrogen atoms in the body, the waves emitted by the atoms during re-alignment are read by a scanner and processed by the computer to produce detailed images of the inner structures of the body in order to find the disorders.

   Is MRCP painful?

We often get asked by the patients whether this test causes any pain, the simple answer is no, as this non-invasive scan utilizes magnetic radiowaves which don't affect the body itself in any way.

   Difference between MRI and MRCP

Some people take MRI and MRCP as totally different tests, in reality MRCP is just a special MRI scan that focuses on the biliary and pancreatic system, specifically the biliary and pancreatic ducts.

How MRCP is interpreted

Once the scan is done, the images of the scan are reviewed by a trained radiologist who does the interpretation and reports the findings to your primary physician.

 

Risks and benefits of MRCP

The main benefits of MRCP lie in the non-invasive nature and no radiation involved. Also, the MRI scan produces high quality images of the soft tissues, hence more definite characterization of diseases can be made e.g. stones, tumours, inflammation, infections and strictures.

 The contrast agents utilized in the mri scan cause less allergic reactions and renal injury compared to those containing iodine.

There are some limitations too which might necessitate other interventions;

Persons with metallic implants and devices cannot proceed with MR scan.

Claustrophobic people might not tolerate the scan time

Patients unable to hold breath or lay still might make the scan less accurate.

Cost & availability is a major limiting factor regarding MRI scan in non-tertiary care setups.

 

MRCP vs ERCP: difference, pros and cons

ERCP is a type of endoscopic procedure that is used to diagnose the pancreas and bile ducts. It is a test that can be done on an outpatient basis.  A small tube called an endoscope is inserted into the mouth, throat, or nose and then passed through the esophagus, stomach, and duodenum until it reaches the upper part of the small intestine. The doctor inserts a device called a catheter through the endoscope into one of two ducts in order to inject dye. The dye lets the biliary & pancreatic channels be visualized.

Compared to MRCP the ERCP has some pros and cons as well:

PROS of ERCP;

Diagnostic as well as therapeutic procedure ( e.g. any biliary duct stone can be removed, any blockage can be opened or stent placed and biopsy samples can be taken) meanwhile MRCP is just a diagnostic test only.

The diagnostic efficacy is comparable between ERCP and MRCP.

Nephrogenic systemic fibrosis is a rare complication of gadolinium based contrasts used in MRCP, in comparison no IV contrast is given in ERCP. 

Cons:

ERCP is an invasive procedure which requires sedation and is a day case procedure, with some minor risks of bleeding and perforation along with pancreatitis.

The MRCP test is more sensitive than an ERCP when it comes to detecting gallstones or pancreatitis, but it cannot identify stones as small as those that can be seen with an ERCP.

What is the cost of MRCP test?

In USA the MRCP test costs from $300 to $1500 depending upon insurance.

In UK the MRCP scan costs varies from GBP 300 - 360

In Pakistan the MRCP scan costs around PKR 15000.

References:

Griffin N, Charles-Edwards G, Grant LA. Magnetic resonance cholangiopancreatography: the ABC of MRCP. Insights Imaging. 2012;3(1):11-21. doi:10.1007/s13244-011-0129-9

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