Magnetic resonance cholangiopancreatography (MRCP): MR imaging and anatomy of the biliary tract, gallbladder and pancreatic duct

Magnetic resonance cholangiopancreatography (MRCP): MR imaging and anatomy of the biliary tract, gallbladder and pancreatic duct

Magnetic resonance cholangiopancreatography (MRCP): MR imaging and anatomy of the biliary tract, gallbladder and pancreatic duct


This anatomical module of e-Anatomy is dedicated to the anatomy of the biliary tract on MRI on a MRCP (magnetic resonance cholangiopancreatography).

To emphasize our pedagogic goal in anatomy, we did not choose a healthy patient where the thin (not dilated) biliary tree may have been difficult to see on MRI, but a patient with dilated biliary tree (intrahepatic ducts and common bile duct) on a choledocholithiasis (gallstone) of the distal common bile duct.

 

Anatomy of the biliary tract, gallblader and pancreatic duct on MRCP: Gallstone; Biliary lithiasis, Biliary sludge
Anatomy of the biliary tract, gallblader and pancreatic duct on MRCP: Gallstone; Biliary lithiasis, Biliary sludge

 

Note that in the case displayed in this module, the patient presents a small anatomical variation of the biliary tree anatomy, type IIIA (the right posterior hepatic duct draining into the left hepatic duct (see diagram below)).

 

We perform a standard protocol of MRCP (magnetic resonance cholangiopancreatography) on a 1.5 T Siemens Aera:

 Axial T2 HASTE: Axial breath-hold T2-weighted turbo spin-echo (TSE), 5 mm slices, on the whole biliary tract. Two breath-hold acquisitions are obtained so that the whole of the liver down to the duodenal ampulla is visualized.

 

MRCP - Axial T2 HASTE: Intrahepatic bile ducts, Right hepatic duct, Left hepatic duct
MRCP - Axial T2 HASTE: Intrahepatic bile ducts, Right hepatic duct, Left hepatic duct

 

 MRCP thick slab (T2 weighted breath-hold HASTE fat-saturated thick slab): A fat saturated HASTE sequence where a single slab of data 4 cm in thickness is acquired in a 1- to 2-s breath-hold in 3 different coronal planes. MIP images have also been displayed.

 

MRCP thick slab: Cystic duct, Bile duct, Pancreatic duct, Gallbladder
MRCP thick slab: Cystic duct, Bile duct, Pancreatic duct, Gallbladder

 

 Axial T2 HASTE 4 mm on CBD: An axial breath-hold T2-weighted turbo spin-echo (TSE), 4 mm slices only on the dilated common bile tract.

 

Magnetic resonance cholangiopancreatography (MRCP): Axial T2 HASTE 4 mm on CBD (Bile duct)
Magnetic resonance cholangiopancreatography (MRCP): Axial T2 HASTE 4 mm on CBD (Bile duct)

 

 Axial T1 in-phase and axial T1 out-of-phase on the liver: Conventional abdominal MRI imaging to study extraductal structures (hepatic segments, pancreas, spleen, kidneys)

 

Axial T1 in-phase: Hepatic segmentation
Axial T1 in-phase: Hepatic segmentation

 

Axial T1 out-of-phase: MRI - Liver - Pancreas
Axial T1 out-of-phase: MRI - Liver - Pancreas

 

 Axial T1 VIBE FS: A 3D fat suppressed T1-weighted GRE sequence without intravenous contrast administration to evaluate the duct walls, and any focal parenchymal pathology.

 

Abdomen - MRI: Peritoneum, Stomach,  Duodenum, Kidney
Abdomen - MRI: Peritoneum, Stomach, Duodenum, Kidney

 

Coronal true FISP: This sequence is the first of our MRCP protocol, on the upper abdomen to establish the location of the extrahepatic bile ducts. But in this module of e-Anatomy we have positioned this sequence at the end, as it does not provide much useful information on the biliary tract.

 

Coronal true FISP - MRCP: Gallbladder, Liver, Stomach
Coronal true FISP - MRCP: Gallbladder, Liver, Stomach

 

 

Anatomy of the biliary tract, gallblader and pancreatic duct on MRCP: Gallstone; Biliary lithiasis, Biliary sludge
Anatomy of the biliary tract, gallblader and pancreatic duct on MRCP: Gallstone; Biliary lithiasis, Biliary sludge
MRCP - Axial T2 HASTE: Intrahepatic bile ducts, Right hepatic duct, Left hepatic duct
MRCP
MRCP thick slab: Cystic duct, Bile duct, Pancreatic duct, Gallbladder
MRCP thick slab: Cystic duct, Bile duct, Pancreatic duct, Gallbladder
Magnetic resonance cholangiopancreatography (MRCP): Axial T2 HASTE 4 mm on CBD (Bile duct)
Magnetic resonance cholangiopancreatography (MRCP): Axial T2 HASTE 4 mm on CBD (Bile duct)
Axial T1 in-phase: Hepatic segmentation
Axial T1 in
Axial T1 out-of-phase: MRI - Liver - Pancreas
Axial T1 out
Abdomen - MRI: Peritoneum, Stomach,  Duodenum, Kidney
Abdomen
Coronal true FISP - MRCP: Gallbladder, Liver, Stomach
Coronal true FISP
  • Griffin N, Charles-Edwards G, Grant LA. Magnetic resonance cholangiopancreatography: the ABC of MRCP. Insights Imaging. 2012;3(1):11–21. doi:10.1007/s13244-011-0129-9
  • Normal anatomy and anatomic variants of the biliary tree and pancreatic ductal system at MRCP – what the clinicians want to know - J. Ressurreição - ECR 2014 - http://dx.doi.org/10.1594/ecr2014/C-1696
  • Terminologia anatomica: international anatomical terminology By the Federative Committee on Anatomical Terminology (FCAT).  Stuttgart:  Georg Thieme Verlag.  ISBN-10: 3-13-114361-4. ISBN-13: 978-3-13-114361-7.