Pitfalls in MR cholangiopancreatographic interpretation

Hiroyuki Irie, Hiroshi Honda, Toshiro Kuroiwa, Kengo Yoshimitsu, Hitoshi Aibe, Kenji Shinozaki, Kouji Masuda

    Research output: Contribution to journalArticlepeer-review

    128 Citations (Scopus)


    Magnetic resonance (MR) cholangiopancreatography (MRCP) is widely used in the evaluation of pancreatobiliary disorders. However, numerous related pitfalls may simulate or mask pancreatobiliary disease. Maximum-intensity-projection (MIP) reconstructed images completely obscure small filling defects and may demonstrate respiratory motion artifacts. T2 weighting may vary with different MR imaging sequences and influence MRCP findings. Incomplete imaging may create confusion regarding ductal anatomy or disease. Furthermore, MRCP yields only static images and thus may fail to depict various anomalies. Limited spatial resolution makes differentiation between benign and malignant strictures with MRCP alone extremely difficult. Susceptibility artifacts may be caused by metallic foreign bodies or gastric-duodenal gas. Fluid accumulation may produce a pseudolesion or pseudostricture, although changing the imaging angle or section thickness may be helpful. Pneumobilia may be misinterpreted as bile duct stones, and true stones may be overlooked. Pulsatile vascular compression can cause pseudo-obstruction of the bile duct. Use of both source and MIP reconstructed images obtained from different angles can help avoid cystic duct-related pitfalls. Repeat MRCP or conventional MR imaging can help avoid pitfalls related to the periampullary region. Segmental collapse of the normal main pancreatic duct may be misinterpreted as stenosis, but administration of secretin is helpful. An awareness of these pitfalls and possible solutions is crucial for avoiding misinterpretation of MRCP images.

    Original languageEnglish
    Pages (from-to)23-37
    Number of pages15
    Issue number1
    Publication statusPublished - 2001

    All Science Journal Classification (ASJC) codes

    • Radiology Nuclear Medicine and imaging


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