Tips from Other Journals

Use of Magnetic Resonance Cholangiopancreatography


Am Fam Physician. 2004 May 1;69(9):2240-2242.

Management of suspected biliary disease requires accurate evaluation for biliary obstruction. Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for evaluation of the biliary tract, but post-test pancreatitis and even death are possible. Magnetic resonance cholangiopancreatography (MRCP) provides clear visualization of the biliary and pancreatic ducts. Contrast agents are not needed because stagnant fluids have high-signal intensity and contrast distinctively with nearby solid tissue and fast-moving fluids such as blood. Magnetic resonance imaging (MRI) done at the same time can add information about malignant disorders. Because ERCP may be necessary after MRCP, Romagnuolo and associates reviewed the utility of MRCP in suspected biliary disease.

The authors performed a meta-analysis of studies comparing MRCP with other diagnostic modalities in a variety of disease states. Among the 67 articles included, the imaging end points used were presence of obstruction (30 studies with 1,954 patients), level of obstruction (eight studies with 572 patients), presence of biliary lithiasis (46 studies with 3,592 patients), and presence of malignancy (22 studies with 1,294 patients).

The overall adjusted sensitivity and specificity were 95 and 94 percent, respectively. The results for each end point were high, although sensitivity was slightly lower for the diagnosis of stones and differentiation of benign from malignant biliary obstructions.

The authors conclude that MRCP is highly accurate in the detection of biliary tract obstruction but less accurate in distinguishing benign from malignant lesions causing obstruction. Choledocholithiasis is accurately identified, but small stones in normal ducts may not be visualized. Further studies will help clarify which patients will benefit most from MRCP.

Romagnuolo J, et al. Magnetic resonance cholangiopancreatography: a meta-analysis of test performance in suspected biliary disease. Ann Intern Med. October 7, 2003, 139:547–57.



Copyright © 2004 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


Jan 2022

Access the latest issue of American Family Physician

Read the Issue

Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article