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Passive und aktive Magnetresonanz-Cholangiopankreatikographie

Technik, Indikation und typische Anatomie

Passive and active magnetic resonance cholangiopancreatography

Technique, indications, and typical anatomy

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Zusammenfassung

Klinisches/methodisches Problem

In der täglichen Routine ist der Radiologe mit diversen Fragestellungen in Bezug auf die Gallenwege und das Pankreas konfrontiert.

Radiologische Standardverfahren

Die Magnetresonanz-Cholangiopankreatikographie (MRCP) gilt heutzutage neben der Sonographie als Methode der Wahl bei zahlreichen Fragestellungen, die das Gallen- und Pankreasgangsystem betreffen, und wird einer invasiven endoskopischen retrograden Cholangiopankreatikographie (ERCP) im rein diagnostischen Setting vielfach vorgezogen.

Methodische Innovationen

Seit ihrer Vorstellung im Jahr 1991 wurde die MRCP kontinuierlich weiterentwickelt. Zu nennen sind insbesondere die Reduktion der Akquisitionszeit durch schnelle Fast-Spin-Echo-Sequenzen (FSE), die Möglichkeit der Atemtriggerung und die kontrastmittelverstärkte Darstellung der Gallenwege mittels hepatobiliär eliminiertem Kontrastmittel.

Leistungsfähigkeit

Viele Diagnosen können bereits in nativer Untersuchungstechnik gestellt werden. Mittels zusätzlich appliziertem, hepatobiliär eliminiertem Kontrastmittel ist auch eine Aussage über die Flussdynamik der Galle möglich. Insbesondere im postoperativen und postinterventionellen Situs bietet dies einen Mehrwert.

Bewertung

Vorteile der MRCP sind neben Robustheit und Reproduzierbarkeit insbesondere der modulare Protokollaufbau, der eine Anpassung der Untersuchung an die klinische Fragestellung ermöglicht.

Empfehlung für die Praxis

Die MRCP ist ein zuverlässiges und risikoarmes bildgebendes Verfahren in der Primärdiagnostik und Verlaufskontrolle biliärer und pankreatischer Pathologien.

Abstract

Clinical/methodical issue

In daily routine, every radiologist is confronted with a variety of questions concerning the biliary tract and pancreatic system.

Standard radiological methods

Today, besides sonography, magnetic resonance cholangiopancreatography (MRCP) is considered the method of choice in the investigation of many disorders of the hepatobiliary and pancreatic system and is commonly preferred over invasive ERCP in a mere diagnostic setting.

Methodical innovations

Since its introduction in 1991, MRCP has constantly evolved. Major innovations have been the reduction of acquisition time by using fast spin echo (FSE) sequences, the use of respiratory gating and contrast-enhanced imaging of the bile ducts with hepatobiliary-specific MRI contrast agents.

Performance

Many diagnoses may already be made with noncontrast enhanced images. By supplemental administration of a hepatobiliary-specific contrast agent, it is also possible to evaluate the flow dynamics of the bile. This is of additional value especially in patients who underwent surgery of the biliodigestive system or endoscopic interventions.

Achievements

Aside from robustness and reproducibility, a major advantage of this technique is the modular design of imaging protocols, which can easily be adapted to the clinical question.

Practical recommendations

MRCP is a reliable and low-risk imaging method for primary diagnosis and follow-up of biliary and pancreatic pathologies.

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Authors and Affiliations

  1. Klinik für Radiologie und Nuklearmedizin, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz

    J. Vosshenrich, D. T. Boll & C. J. Zech

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  1. J. Vosshenrich
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  2. D. T. Boll
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  3. C. J. Zech
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Correspondence to J. Vosshenrich.

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Interessenkonflikt

J. Vosshenrich, D.T. Boll und C.J. Zech geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Vosshenrich, J., Boll, D.T. & Zech, C.J. Passive und aktive Magnetresonanz-Cholangiopankreatikographie. Radiologe 59, 306–314 (2019). https://doi.org/10.1007/s00117-019-0507-8

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