MRCP – Magnetresonanzcholangiopankreatografie

Zusammenfassung

Die Magnetresonanzcholangiopankreatografie (MRCP) ist eine spezielle MR-Technik zur Darstellung und Beurteilung der Gallenwege und Pankreasgänge. Durch technische Weiterentwicklungen der klassischen T2w Sequenzen und die Verfügbarkeit der kontrastmittelgestützten T1w Sequenzen ist die MRCP der endoskopisch retrograden Cholangiopankreatografie (ERCP) aktuell diagnostisch ebenbürtig. Daher spielt die MRCP eine fundamentale Rolle in der Diagnostik hepatobiliärer und pankreatischer Erkrankungen, die in diesem Übersichtsartikel neben der Technik der Sequenzaufnahme und der zugrunde liegenden Anatomie näher beleuchtet werden.

Abstract

Magnetic resonance cholangiopancreatography (MRCP) is a special MR technique to display and analyze the biliary tract and pancreatic ducts. MRCP sequences are equivalent to endoscopic retrograde cholangiopancreatography (ERCP) for diagnostic purposes due to technical developments of the classical T2 weighted MRCP sequences and the availability of contrast enhanced T1 weighted sequences. Therefore, MRCP plays a fundamental role in the diagnoses of hepatobliary and pancreatic diseases, which are presented in this review article as are technical details of sequence acquisitions and the underlying anatomy.

Kernaussagen

Die MRCP hat sich über das letzte Vierteljahrhundert als Untersuchung der Wahl zur nicht invasiven Abklärung einer Vielzahl von Veränderungen an Gallengängen und Pankreasgang etabliert. Dazu beigetragen haben die technologischen Fortschritte in der Datenakquise und -verarbeitung, sowie Kontrastmittel, die über ihre biliäre Exkretion der bereits länger möglichen anatomischen Abklärung eine zusätzliche funktionelle Komponente hinzugefügt haben.

Keywords

Magnetic resonance cholangiopancreatography - bile ducts - pancreatic ducts - cholelithiasis - primary sclerosing cholangitis - cholangiocarcinoma

• Literatur

• 1 Wallner BK, Schumacher KA, Weidenmaier W et al. Dilated biliary tract: evaluation with MR cholangiography with a T2-weighted contrast-enhanced fast sequence. Radiology 1991; 181: 805-808
• 2 O'Regan DP, Fitzgerald J, Allsop J et al. A comparison of MR cholangiopancreatography at 1.5 and 3.0 Tesla. Br J Radiology 2005; 78: 894-898
• 3 Schindera ST, Miller CM, Ho LM et al. Magnetic Resonance (MR) Cholangiography: Quantitative and Qualitative Comparison of 3.0 Tesla With 1.5 Tesla. Investigative Radiology 2007; 42: 399-405
• 4 Matsunaga K, Ogasawara G, Tsukano M et al. Usefulness of the navigator-echo triggering technique for free-breathing three-dimensional magnetic resonance cholangiopancreatography. Magnetic Resonance Imaging 2013; 31: 396-400
• 5 Sodickson A, Mortele KJ, Barish MA et al. Three-dimensional Fast-Recovery Fast Spin-Echo MRCP: Comparison with Two-dimensional Single-Shot Fast Spin-Echo Techniques. Radiology 2006; 238: 549-559
• 6 Frydrychowicz A, Lubner MG, Brown JJ et al. Hepatobiliary MR Imaging with Gadolinium Based Contrast Agents. J Magn Reson Imaging 2012; 35: 492-511
• 7 Kirchin MA, Pirovano GP, Spinazzi A. Gadobenate Dimeglumine (Gd-BOPTA): An Overview. Investigative Radiology 1998; 33: 798-809
• 8 Carlos RC, Branam JD, Dong Q et al. Biliary imaging with Gd-EOB-DTPA: is a 20-minute delay sufficient?. Acad Radiol 2002; 9: 1322-1325
• 9 Ringe KI, Gupta RT, Brady CM et al. Respiratory-triggered Three-dimensional T2-weighted MR Cholangiography after Injection of Gadoxetate Disodium: Is It Still Reliable?. Radiology 2010; 255: 451-458
• 10 Mortelé KJ, Ros PR. Anatomic Variants of the Biliary Tree. Am J Roentgenol 2001; 177: 389-394
• 11 Griffin N, Charles-Edwards G, Grant LA. Magnetic resonance cholangiopancreatography: the ABC of MRCP. Insights into Imaging 2012; 3: 11-21
• 12 Griffin N, Yu D, Grant AL. Magnetic Resonance Cholangiopancreatography: Pearls, Pitfalls, and Pathology. Semin Ultrasound CT MR 2013; 34: 32-43
• 13 Vogl TJ, Schwarz WO, Heller M et al. Staging of Klatskin tumours (hilar cholangiocarcinomas): comparison of MR cholangiography, MR imaging, and endoscopic retrograde cholangiography. Eur Radiol 2006; 16: 2317-2325
• 14 Hyodo T, Kumano S, Kushihata F et al. CT and MR cholangiography: advantages and pitfalls in perioperative evaluation of biliary tree. Br J Radiol 2012; 85: 887-896
• 15 Blair PS, Low G. Biliary Anastomotic Leakage following Orthotopic Liver Transplant: The Use of Primovist (Gadoxetate Disodium) as an Intravenous MR Cholangiography Contrast Agent for Biliary Leakage. J Clin Imag Sci 2014; 4: 75
• 16 Kantarcı M, Pirimoglu B, Karabulut N et al. Non-invasive detection of biliary leaks using Gd-EOB-DTPA-enhanced MR cholangiography: comparison with T2-weighted MR cholangiography. Eur Radiol 2013; 23: 2713-2722
• 17 Boraschi P, Donati F. Postoperative biliary adverse events following orthotopic liver transplantation: Assessment with magnetic resonance cholangiography. World J Gastroenterol 2014; 20: 11.080-11.094
• 18 Hintze RE, Adler A, Veltzke W et al. Endoscopic management of biliary complications after orthotopic liver transplantation. Hepatogastroenterology 1997; 44: 258-262
• 19 Kinner S, Umutlu L, Dechêne A et al. Biliary Complications after Liver Transplantation: Addition of T1-weighted Images to MR Cholangiopancreatography Facilitates Detection of Cast in Biliary Cast Syndrome. Radiology 2012; 263: 429-436
• 20 Tirkes T, Sandrasegaran K, Sanyal R et al. Secretin-enhanced MR Cholangiopancreatography: Spectrum of Findings. RadioGraphics 2013; 33: 1889-1906
• 21 Sanyal R, Stevens T, Novak E et al. Secretin-Enhanced MRCP: Review of Technique and Application With Proposal for Quantification of Exocrine Function. Am J Roentgenol 2012; 198: 124-132
• 22 Matos C, Metens T, Devière J et al. Pancreatic duct: morphologic and functional evaluation with dynamic MR pancreatography after secretin stimulation. Radiology 1997; 203: 435-441
• 23 Rustagi T, Njei B. Magnetic Resonance Cholangiopancreatography in the Diagnosis of Pancreas Divisum: A Systematic Review and Meta-analysis. Pancreas 2014; 43: 823-828
• 24 Machado NO, al Qadhi H, al Wahibi K. Intraductal Papillary Mucinous Neoplasm of Pancreas. N Am J Med Sci 2015; 7: 160-175
• 25 Castelli F, Bosetti D, Negrelli R et al. Multifocal branch-duct intraductal papillary mucinous neoplasms (IPMNs) of the pancreas: magnetic resonance (MR) imaging pattern and evolution over time. La radiologia medica 2013; 118: 917-929