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AbdominalImaging Springer-Verlag New York, LLC. 2004
Published online: 14 January 2004Abdom Imaging (2004) 29:360 387
DOI: 10.1007/s00261-003-0119-6INVITED REVIEWMRCP pitfallsL. Van Hoe, K. Mermuys, P. VanhoenackerDepartment of Radiology, Onze Lieve Vrouw Hospital Aalst, Moorselbaan 164, 9300 Aalst, BelgiumMagnetic resonance cholangiopancreatography (MRCP) is
being used increasingly for noninvasive diagnostic evaluation of pancreatobiliary disease [1 41]. This technique basically exploits the long T2 relaxation times of stationary or
slow-moving nonhemorrhagic fluid and displays bile and
pancreatic juices with a high signal intensity on T2-weighted
images. Although MRCP images resemble images obtained
with endoscopic retrograde cholangiopancreatography
(ERCP), the underlying physics and principles are largely
different. For radiologists and non-radiologists, it takes time
to become familiar with the MRCP appearance of common
and uncommon variants and pathologic conditions. In particular those who have extensive experience with ERCP
initially may be disappointed when MRCP and ERCP images obtained in the same patient show different features.
Initially, they may claim that MRCP missed the disease.
After a learning curve of variable time, they may learn that
the information is the same, but the presentation may be
different. Further, they may understand that the capability to
combine MRCP with unenhanced and dynamic multiphase
contrast-enhanced cross-sectional magnetic resonance imaging (MRI) is unique and gives MRCP an unrivaled diagnostic potential [1].We provide an overview of the different types of pitfalls
in MRCP. Pitfalls related to the technique are those that have
an obvious link with the underlying MR physics and are
unique for MRCP. Pitfalls related to the intrinsic limitations
of ductal imaging are shared by MRCP and ERCP and are
caused by the fact that some diseases may present without
ductal abnormalities, or may induce ductal changes only in a
late stage. Moreover, ductal abnormalities may be aspecific,
and correlation with findings at cross-sectional MRI may be
mandatory. We also discuss the pitfalls related to anatomic
variants and to specific diseases. Some of these are also
encountered in ERCP, whereas others are unique for MRCP.Pitfalls related to MRI techniqueBasically, there are three different MR techniques to obtain
cholangiographic images with MRI. In the first and mostCorrespondence to: L. Van Hoe; email: [email protected]. 1. Limitations of MIP images. Patient with jaundice
after gallbladder surgery. MIP image obtained after postprocessing of a series of thin slices...