Comparison of magnetic resonance cholangiopancreatography versus ERCP in the evaluation of suspected pancreatic pathology

Magnetic resonance cholangiopancreatography (MRCP) is a fairly new imaging technique which allows noninvasive visualization of the biliary and pancreatic systems. We set forth to compare the diagnostic accuracy of magnetic resonance pancreatography (MRP) to ERCP in detecting pancreatic pathology. Methods: Through a computerized review of records, 34 patients were identified who had undergone both ERCP and MRP within 6 weeks for suspected pancreatic pathology. The MRP and ERCP reports were independently reviewed and analyzed by blinded investigators for the presence or absence of the following: obstruction, pancreatic duct (PD) dilation, stricture, malignancy, stone, pancreatitis, and pancreatic divisum. Results: ERCP + MRCP + p value Obstruction 16 14 ns Dilation 7 15 0.03 Stricture 18 3 <0.001 Malignancy 11 14 ns Pancreatic divisum 6 3 ns Pane. Duct stone 1 0 ns There was no significant difference in MRP's ability to detect obstruction or malignancy. MRP failed to detect 3 of 6 patients with pancreatic divisum found at ERCP but this did not reach statistical significance. MRP was superior at determining PD dilation beyond points of total obstruction. Conclusions: MRP improved imaging of pancreatic pathology beyond areas of obstruction while ERCP provided better imaging of strictures in nondilated PDs. Further study is necessary to determine the sensitivity of MRP in detecting pancreatic divisum and PD stones.