MRCP Scan in Dehradun bile duct & pancreatic duct imaging

What an MRCP scan shows

It is performed as part of, or alongside, an abdominal MRI, and it takes about half an hour. No instrument is passed, nothing is injected for a standard study, and there is no sedation and no radiation.

What it is looking for is obstruction and its cause. A stone in the common bile duct. A stricture, and whether that stricture looks benign or malignant. A mass at the head of the pancreas compressing the duct. A congenital variant such as pancreas divisum. Dilatation upstream of a blockage, which tells the radiologist where the obstruction sits even before its cause is visible.

How MRCP works without contrast

MRCP relies on a straightforward piece of physics. It uses heavily T2-weighted sequences, which are tuned so that slow-moving or static fluid appears extremely bright while almost everything else — liver, pancreas, muscle, flowing blood — appears dark.

Bile and pancreatic juice are static fluid. On these sequences they light up brilliantly against a black background, and the duct system effectively draws itself. The images are then reconstructed into a projection that looks remarkably like the picture an ERCP produces by injecting dye, but obtained entirely non-invasively.

Why your doctor ordered an MRCP

Jaundice with dilated ducts on ultrasound

This is the commonest reason. Ultrasound shows that the ducts are dilated, which establishes that something is obstructing them, but frequently cannot show what or exactly where. Gas in the duodenum obscures the lower common bile duct on ultrasound in a large proportion of patients. MRCP sees the entire duct regardless.

Suspected stone in the common bile duct

Gallstones are common, and a stone that has migrated out of the gallbladder into the bile duct causes pain, jaundice, abnormal liver enzymes and sometimes pancreatitis. MRCP finds these reliably and, importantly, also shows convincingly when there is no stone — which spares the patient an ERCP they did not need.

Before gallbladder surgery

Where liver enzymes are abnormal or the duct looks borderline on ultrasound, MRCP before cholecystectomy establishes whether a duct stone needs clearing first. Discovering one after surgery is a considerably worse outcome than finding it before.

Unexplained or recurrent pancreatitis

Pancreatitis with no obvious cause needs the ducts examining. MRCP identifies a small stone, a stricture, a duct anomaly such as pancreas divisum, or an early cystic lesion communicating with the duct.

Characterising a pancreatic cyst

Whether a pancreatic cyst communicates with the duct is one of the main features separating a branch-duct intraductal papillary mucinous neoplasm from a harmless simple cyst. That is an MRCP question, and the answer changes whether the patient enters surveillance.

Suspected cholangiocarcinoma or sclerosing cholangitis

MRCP shows the pattern of stricturing along the duct tree. Multiple short strictures alternating with dilated segments suggests primary sclerosing cholangitis; a single abrupt stricture with a mass raises concern for cholangiocarcinoma.

MRCP or ERCP — the important distinction

The practical consequence is that MRCP is usually done first. If it is normal, the patient avoids an invasive procedure with a real complication rate. If it shows a stone or a stricture, ERCP is then performed knowing exactly what needs doing, which makes it quicker and safer. Using ERCP purely to find out whether something is there exposes a large number of people to pancreatitis risk unnecessarily.

What the report will describe

• Duct calibre. The common bile duct is normally up to about 6 mm, a little wider with age and after gallbladder removal. Dilatation indicates obstruction.
• Level of obstruction. Where the duct changes from dilated to normal, which localises the blockage even when the cause is subtle.
• Filling defects. Stones appear as dark spots within the bright bile. Number, size and position are given, because they determine how an ERCP would be planned.
• Strictures. Length, whether the shoulders are smooth or abrupt, and whether there is associated soft tissue — the features that separate benign from malignant.
• Pancreatic duct. Calibre, side-branch changes, and any communication with a cyst.
• Anatomical variants. Pancreas divisum, an aberrant right hepatic duct, a low cystic duct insertion. These matter enormously to a surgeon operating in that region.
• The gallbladder and liver alongside, since the abdominal sequences cover them.

Preparing for your MRCP in Dehradun

• Fast for four to six hours. This is the single most important thing you can do. Sips of water may be allowed; confirm when you book.
• Take your usual medication with a small amount of water unless told otherwise. Tell us in advance if you are diabetic so the slot can be timed sensibly.
• Bring prior imaging and blood results. The ultrasound that prompted the scan, and recent liver function tests, materially change how the images are interpreted.
• Mention previous surgery. Gallbladder removal, a bile duct operation, a previous stent or a Whipple procedure all alter the expected anatomy. The radiologist needs to know.
• Declare all implants. Pacemaker, defibrillator, neurostimulator, cochlear implant, aneurysm clip or metal fragments.
• Be ready to hold your breath for fifteen to twenty seconds at a time.

What an MRCP feels like

It is an ordinary MRI. You lie on your back with a coil over your upper abdomen and go into the bore head first. Nothing is inserted, and for a standard MRCP nothing is injected.

You are given earplugs or headphones for the noise and a squeeze-ball that stops the scan instantly. The technologist speaks to you between sequences and asks you to hold your breath for some of them.

Occasionally you may be given a small amount of an oral agent to drink beforehand, which suppresses the bright signal from fluid in the stomach and duodenum so it does not overlap the ducts. If that applies, it will be explained on the day.

What MRCP cannot do

It is also less sensitive for very small stones, particularly those under about 3 mm, which can sit below the resolution of the sequence. A strongly suspicious clinical picture with a normal MRCP sometimes still leads to endoscopic ultrasound or ERCP.

Image quality depends heavily on the patient being able to lie still and hold their breath. Ascites, a large amount of bowel gas, or a metallic surgical clip near the duct can all degrade the study. And a duct that is obstructed but not yet dilated — which can happen very early — may look deceptively normal.

MRCP cost in Dehradun

Which parts of Dehradun we cover

• Rajpur Road
• Dalanwala
• Clement Town
• Prem Nagar
• Vasant Vihar
• Jakhan
• Sahastradhara Road
• Race Course
• Patel Nagar
• GMS Road
• Ballupur
• Kaulagarh
• Doiwala
• Selaqui
• ISBT Dehradun
• Mussoorie
• Rishikesh
• Haridwar
• Vikasnagar

Common reference points patients use when giving directions: Clock Tower, Doon Hospital, the ISBT, Graphic Era, Max Super Speciality Hospital and Pacific Mall. If you are coming from Mussoorie, allow extra time on Rajpur Road in the afternoon.

MRCP in Dehradun: frequently asked questions