Magnetic resonance cholangio-pancreatography (MRCP) in the diagnostic process of biliary and panceratic diseases

Background: MRCP appeared in the diagnostic armory more than 20 years ago. The technique allows the selective examination of the pancreas and the biliary ducts. Aim: We compared the diagnostic accuracy of MRCP and ERCP.

Patients: Because of pancreatico-biliary disease, MRCP was performed in 16 patients (mean age: 58.2 years; female-male ratio: 8/8) in our department in the past two years. MRCP diagnoses were choledocholithiasis (1 case), Klatskin tumour (4 cases), cholangiocarcinoma (2 cases), intraductal mucinous pancreatic tumour (1 case), hepatic metastasis (1 case), choledochocele (1 case), hepatico-jejunostomy (1 case), Oddi spincter dysfunction (1 case), transient biliary obstruction (1 case) and no pathology (2 cases).

Results: In 7 cases, ERCP was not necessary after MRCP. ERCP and MRCP gave the same diagnosis in 7 cases, while in 2 cases the diagnoses by ERCP and MRCP were different. The most MRCP investigation has been performed because of malignancies (8 cases). In 1 case, ERCP was unsuccessful (hepatico-jejunostomy, therefore, we used MRCP.

Conclusions: The diagnoses of ERCP and MRCP were equal in most of the cases. MRCP changed the diagnostic procedure of pancreatico-biliary diseases, since in 50% of MRCP cases ERCP was not necessary to perform. In operable malignant pancreatico-biliary processes, we did not investigate patients with ERCP. It seems that instead of ERCP, the non-invasive MRCP, if available, should be the first diagnostic step in patients with obstructive jaundice with unknown origin.