Magnetic Resonance Cholangiopancreatography: Current Use and Future Applications  Vikram A. Sahni, Koenraad J. Mortele  Clinical Gastroenterology and Hepatology  Volume 6, Issue 9, Pages 967-977 (September 2008) DOI: 10.1016/j.cgh.2008.05.017 Copyright © 2008 AGA Institute Terms and Conditions

Figure 1 (A) Oblique coronal, thick slab MRCP image and (B) maximum intensity projection MRCP image show normal common duct (short arrow), main pancreatic duct (long arrow), and gallbladder (*). Clinical Gastroenterology and Hepatology 2008 6, 967-977DOI: (10.1016/j.cgh.2008.05.017) Copyright © 2008 AGA Institute Terms and Conditions

Figure 2 Oblique coronal, thick slab MRCP images (A) before, (B) 5 minutes after, and (C) 10 minutes after intravenous injection of secretin. (B) Normal early mild dilatation of the pancreatic duct (black arrow) with (C) return to baseline shows normal pancreatic duct compliance. (A–C) Progressive filling of the duodenum (white arrows) shows normal exocrine pancreatic function. Clinical Gastroenterology and Hepatology 2008 6, 967-977DOI: (10.1016/j.cgh.2008.05.017) Copyright © 2008 AGA Institute Terms and Conditions

Figure 3 Oblique coronal, thick slab MRCP image shows triple confluence of the right anterior, right posterior, and left hepatic ducts (arrow). Clinical Gastroenterology and Hepatology 2008 6, 967-977DOI: (10.1016/j.cgh.2008.05.017) Copyright © 2008 AGA Institute Terms and Conditions

Figure 4 Oblique coronal, thick slab MRCP image shows pancreas divisum. The dorsal duct (short solid white arrow) crosses anterior to the common bile duct (open arrow) to empty into the minor papilla. An incidental intraductal papillary mucinous neoplasm is seen to arise from the ventral duct (long solid white arrow). Clinical Gastroenterology and Hepatology 2008 6, 967-977DOI: (10.1016/j.cgh.2008.05.017) Copyright © 2008 AGA Institute Terms and Conditions

Figure 5 Annular pancreas. (A) Oblique coronal, thick slab MRCP image shows a pancreatic duct (solid white arrow) that encircles the second part of the duodenum (open arrow). (B) Axial T1-weighted, unenhanced, 3-dimensional spoiled gradient-echo fat-suppressed MR image shows pancreatic parenchyma (arrow) encircling the duodenum. Clinical Gastroenterology and Hepatology 2008 6, 967-977DOI: (10.1016/j.cgh.2008.05.017) Copyright © 2008 AGA Institute Terms and Conditions

Figure 6 Oblique coronal, thick slab MRCP image shows an impacted low-signal stone in the distal common duct (*) with intrahepatic (arrows) and extrahepatic biliary dilatation. Clinical Gastroenterology and Hepatology 2008 6, 967-977DOI: (10.1016/j.cgh.2008.05.017) Copyright © 2008 AGA Institute Terms and Conditions

Figure 7 Klatskin tumor. (A) Oblique coronal, thick slab MRCP image shows an obstructing tumor (*) with intrahepatic left and right lobe biliary dilatation (arrows). (B) Contrast-enhanced late portal venous axial T1-weighted 3-dimensional spoiled gradient-echo fat-suppressed MR image shows an ill-defined enhancing mass at the liver hilum (white arrows). Dilated biliary ducts are present (black arrows). Clinical Gastroenterology and Hepatology 2008 6, 967-977DOI: (10.1016/j.cgh.2008.05.017) Copyright © 2008 AGA Institute Terms and Conditions

Figure 8 Pancreatic adenocarcinoma. (A) Contrast-enhanced axial T1-weighted 3-dimensional spoiled gradient-echo fat-suppressed MR image shows a hypointense mass in the head of the pancreas (arrow). Oblique coronal, thick slab (B) MRCP image and (C) ERCP image show dilatation of the common duct (open arrow) and the pancreatic duct (solid white arrow) by a pancreatic adenocarcinoma (* in B). Clinical Gastroenterology and Hepatology 2008 6, 967-977DOI: (10.1016/j.cgh.2008.05.017) Copyright © 2008 AGA Institute Terms and Conditions

Figure 9 (A) Oblique coronal, thick slab MRCP image shows a cystic pleomorphic pancreatic head mass (arrow) connected to the main pancreatic duct. Findings are in keeping with a side-branch duct IPMN. (B) Single ERCP image shows contrast filling of the same lesion (arrow). Clinical Gastroenterology and Hepatology 2008 6, 967-977DOI: (10.1016/j.cgh.2008.05.017) Copyright © 2008 AGA Institute Terms and Conditions

Figure 10 Oblique coronal, thick slab MRCP image shows multiple short intrahepatic biliary strictures (arrows) alternating with areas of mild dilatation in keeping with primary sclerosing cholangitis. Clinical Gastroenterology and Hepatology 2008 6, 967-977DOI: (10.1016/j.cgh.2008.05.017) Copyright © 2008 AGA Institute Terms and Conditions

Figure 11 Oblique coronal, thick slab MRCP image shows multiple intrahepatic and extrahepatic choledochal cysts (type IVA choledochal cysts). Clinical Gastroenterology and Hepatology 2008 6, 967-977DOI: (10.1016/j.cgh.2008.05.017) Copyright © 2008 AGA Institute Terms and Conditions

Figure 12 Oblique coronal, thick slab MRCP image shows irregular main duct dilatation with side-branch ectasia (short white solid arrows) compatible with chronic pancreatitis. A stricture is noted in the midpancreatic duct (long white arrow). Also note smooth tapering of the intrapancreatic common bile duct (open arrow). Clinical Gastroenterology and Hepatology 2008 6, 967-977DOI: (10.1016/j.cgh.2008.05.017) Copyright © 2008 AGA Institute Terms and Conditions

Figure 13 Oblique coronal, thick slab MRCP images (A) before, (B) 5 minutes after, and (C) 10 minutes after intravenous injection of secretin. There is impaired main duct compliance with reduced and delayed dilatation after the secretin injection. Progressive side branch dilatation (arrows) also is noted. These findings are all in keeping with chronic pancreatitis. Clinical Gastroenterology and Hepatology 2008 6, 967-977DOI: (10.1016/j.cgh.2008.05.017) Copyright © 2008 AGA Institute Terms and Conditions