Magnetic Resonance Cholangiopancreatography (MRCP)

What is a magnetic resonance cholangiopancreatography (MRCP)?

A magnetic resonance cholangiopancreatography (MRCP) is an imaging test to examine your pancreatic and biliary (bile duct) systems. This test uses a dye, infused into your veins through an intravenous (IV) line. The dye (called a contrast agent) helps produce clearer images of your organs and the tubes that connect them. The results help your healthcare provider diagnose conditions and plan treatment.

What does an MRCP diagnose?

Your healthcare provider may recommend an MRCP if you have unexplained abdominal pain.

This specialized type of contrast MRI helps your provider diagnose:

• Bile duct cancer (cholangiocarcinoma).
• Bile duct stones or cysts.
• Blocked or narrowed bile duct (biliary stricture).
• Blocked, narrowed or dilated pancreatic ducts.
• Dilated bile ducts.
• Gallstones.
• Inflammation in the pancreas (pancreatitis) or gallbladder (cholecystitis).
• Pancreatic cancer.
• Pancreatic cysts and pseudocysts.

Who performs an MRCP?

A radiology technologist usually performs an MRCP. A radiologist (a physician who specializes in medical imaging) will also be present and read the test results. MRCP is an outpatient procedure that takes place at a medical clinic or hospital.

What types of MRI scanners are used for MRCP?

Different medical facilities use different MRI scanners. The types include:

• Closed-bore MRI: You lie on an examination table that slides into a large cylinder-shaped tube surrounded by a powerful circular magnet. Your head and abdomen are inside the scanner. Some closed-bore MRIs now have wider tunnel openings (wide-bore MRIs).
• Open-bore MRI: These MRI scanners use magnets that are above and beneath you, but the sides are open. They’re often much easier for people with claustrophobia (or other health concerns that make tight spaces uncomfortable) to tolerate.

What happens before an MRCP?

You should follow your healthcare provider’s instructions to prepare for an MRCP. You may need to:

• Fast (not eat or drink) before the test.
• Make sure a family member or friend can drive you home after the test if you’re receiving sedation.
• Notify your provider of any implanted metal devices you may have, such as a joint replacement, pacemaker or cochlear implant.
• Remove anything that has metal, such as jewelry (including any body piercings), hearing aids and dentures.
• Stop taking medications like nonsteroidal anti-inflammatory drugs (NSAIDs), as well as vitamins and herbal supplements.
• Receive a sedative as a pill or through an IV to help you relax if you have claustrophobia. Your care team may also advise closing your eyes to put you more at ease.
• Tell your provider if you have hay fever (allergic rhinitis), asthma, food allergies or are prone to hives (urticaria). These conditions may slightly increase your risk of an allergic reaction to the contrast dye.

What happens during an MRCP?

During an MRCP, your care team:

1. Offers you earplugs or headphones to help dull the noise of the scanner and protect your hearing. You’ll still be able to hear your care team.
2. Positions you face up on the exam table, using straps and bolsters if needed, to help you stay in the desired position.
3. Places coiling devices that send and receive radio waves around your body.
4. Administers the IV dye, which may cause you to feel a brief cooling sensation.
5. Pushes controls to slide the exam table into the closed-bore MRI tunnel (or you lie on the open-bore table).
6. Leaves the room. The technologist can still see you through a window and communicate with you through a two-way intercom.
7. Runs a sequence of MRI scans. Your body may feel slightly warm. You need to remain still and hold your breath while the scanner takes the images.

How long does an MRCP take?

It takes about 15 minutes to run the series of scans for an MRCP. You may also get a standard abdominal MRI, which can take an extra 30 minutes.

What happens after an MRCP?

You can go home after your vital signs look good and the sedative (if you received one) wears off. Side effects from the dye or procedure are rare. You should alert your care team if you feel nauseated, have a headache or feel like you’re having an allergic reaction. Someone should drive you home after the test. You can resume your usual activities and diet.

What are the benefits of an MRCP?

This specialized contrast MRI produces clear, detailed images of organs and ducts without the use of X-ray radiation. MRCP uses an MRI scanner, which creates an extremely powerful magnetic field and uses radiofrequency waves and computer processing to create images. The radiofrequency waves for an MRI are similar to those used for FM radio broadcasts you can listen to in your car. That means there’s no radiation exposure.

What are the risks of an MRCP?

An MRCP is a relatively safe procedure. Potential risks include:

• Allergic reaction: It’s rare for someone to experience an allergic reaction like anaphylaxis to the IV contrast agent or dye during an MRCP. The dye uses an element called gadolinium instead of iodine since iodine is more likely to cause a reaction.
• Claustrophobia: Lying in an enclosed space like an MRI scanner can be difficult — if not impossible — if you have claustrophobia (fear of enclosed spaces). About 1 in 8 people have claustrophobia, making it one of the more common phobias. Healthcare providers who perform MRCP tests are very familiar with this phobia and can give you a sedative to help you relax during the test.

Who should not get an MRCP?

After an MRCP, your kidneys filter out the contrast dye. But studies suggest that small amounts of the metal may stay in your body for months or years. Most people don’t have any side effects because of it, but people with kidney problems (kidney disease or kidney failure) may not be able to undergo MRCP. You also shouldn’t get an MRCP if you’re pregnant or plan on becoming pregnant within a year.

When should I get the test results?

Your radiologist will read the imaging scans and send the results to your referring healthcare provider. It may take up to a week or two for your provider to get the test results. They’ll review the results with you. Depending on the findings, you may need surgery or a different treatment.

When should I call my healthcare provider?

You should contact your healthcare provider if you develop hives or other signs of an allergic reaction when you get home. You should also let them know if symptoms like abdominal pain worsen.

What’s the difference between an ERCP and an MRCP?

An endoscopic retrograde cholangiopancreatography (ERCP) and MRCP check for the same pancreatic and biliary issues. An ERCP is more invasive and requires anesthesia. Gastroenterologists, doctors who specialize in digestive diseases, perform ERCPs.

During the procedure, your provider:

1. Inserts an endoscope (flexible tube with a camera and light) into your mouth and through the esophagus (food pipe) to reach the small intestine.
2. Slides a catheter (thin, flexible tube) through the endoscope to reach the bile ducts and pancreatic ducts.
3. Injects a dye through the catheter.
4. Uses fluoroscopy (moving X-ray images) to view the ducts as the dye travels through them.

An ERCP may take place at the same time as an upper endoscopy procedure. Your provider can also perform treatments during an ERCP. For instance, they can break up and remove stones or place stents to open blocked ducts. They can also do a biopsy to collect tissue samples for analysis. These procedures aren’t possible with an MRCP.

A note from Cleveland Clinic

The uncertainty of not knowing what’s happening with your body can make you uneasy. An MRCP can provide answers. This relatively low-risk contrast MRI test helps your healthcare provider detect problems like pancreatitis, pancreatic cancer and gallstones. Different types of MRI scanners are available, depending on your needs and preferences. Your provider will discuss next steps with you based on your test findings.