MRI cholangiopancreatography (MRCP)/pancreas protocol

Indications

This protocol is used for evaluation of the biliary tree and pancreas. Indications include biliary ductal dilatation, suspicion of choledocholithiasis, jaundice, pancreatitis, pancreatic mass.

Preparation

• IV contrast agent: 1 mmol/kg gadopentetate dimeglumine at 2 cc/s

• Oral contrast agent: Mixture 3 oz. ferumoxsil and 3 oz. barium sulfate 30 minutes prior to study. If 30 minutes is not available, have patient lie on right side for 5 minutes prior to study

• 2 L nasal oxygen

• At least 24-gauge IV; connect to power injector

• Cover from dome thru entire liver

• Find the best visualization of the ducts and repeat coronal single-shot fast-spin echo slab 30 mm thick 10 times.

Exam sequences

1. (1) Diffusion-weighted imaging b50, 500/ADC – Very sensitive sequence for lesion detection.

2. (2) Axial thin slice single-shot fast-spin echo FS BH – Evaluate for choledocholithiasis.

3. (3) Coronal thin slice single-shot fast-spin echo FS BH – Confirm biliary duct stones, evaluate for ductal stricture.

4. (4) Coronal single-shot fast-spin echo thick slab (30 mm) – Repeat 10 x – Assess distal CBD (ampulla), nice overall image of biliary tree. Repeated images to assure at least one with open sphincter of Oddi.

5. (5–6) Axial T1 in- and out-of-phase (IP/OOP) – Identify focal fat in the pancreas, don’tmistake it for a mass.

6. (7) Axial T1-weighted volume-interpolated gradient echo pre-contrast BH – Identify masses/material which are T1-bright before contrast administration. The fat saturation of this sequence increases relative signal in the pancreas and is good for identifying more subtle pancreatic masses.

7. (8) Axial T1-weighted volume-interpolated gradient echo BH post IV administration of contrast at 20 seconds. Look for hypervascular lesions such as islet cell tumours.

8. (9) Axial T1-weighted volume-interpolated gradient echo BH post IV administration of contrast at 1 minute.

9. (10) Axial T1-weighted volume-interpolated gradient echo BH post IV administration of contrast at 2 minutes.

10. (11) Axial T1-weighted volume-interpolated gradient echo BH post IV administration of contrast at 3 minutes.