MRI of liver and pancreas is important test to diagnose fatty liver disease, liver cancer and bile duct cancer. Should patients have MRCP or ERCP? Should MRCP always be done before ERCP? When MRI of liver and pancreas after screening ultrasound is required? When do patients benefit from imaging of liver, pancreas and biliary system? Leading CT and MRI radiologist explains.

MRI of liver and pancreas. MRCP vs. ERCP. How is liver cancer diagnosed? Dr. Anton Titov, MD. MRI and MRCP use in assessing chronic liver disease. Video interview with leading expert in radiology, CT and MRI specialist. Magnetic Resonance Imaging (MRI) of the abdomen helps to diagnose primary and secondary liver cancer. MRI evaluation of fatty liver helps to quantify extent of liver injury. MRCP is used in nonalcoholic fatty liver disease. MRCP can also preclude need to invasive ERCP test that requires hospital stay. MRI of liver can help in hepatic steatosis grading and NAFLD staging. Medical Second Opinion on MRCP results ensures that liver disease diagnosis is correct and complete. Medical Second Opinion also helps to choose the best treatment strategy for chronic liver disease. Seek medical Second Opinion on fatty liver disease and liver cancer and be confident that your treatment is the best. MRI of liver can also detect hepatic hemangioma, cavernous liver hemangioma and simple hepatic cysts. Evaluation of masses in the noncirrhotic liver by MRCP and ERCP is used frequently. Magnetic resonance cholangiopancreatography is an important test for liver cancer. MRI liver and pancreatic cancer screening and diagnosis. Dr. Anton Titov, MD. Could we turn attention to other organs: MRI imaging of the liver and bile duct system. Magnetic resonance cholangiopancreatography, MRCP, is one of the most detailed ways to assess liver, pancreas and bile duct system. Sometimes someone has a known or suspected problem in liver, pancreas or bile ducts, when would this patient benefit from MRI of liver? Dr. Anton Titov, MD. What should patient expect from MRCP or MRI of liver? Dr. Anton Titov, MD. Dr. Kent Yucel, MD. MRI and CT specialist, Tufts Medical Center. The hepatobiliary system is primarily evaluated by ultrasound, similar to the heart situation. The first test is an ultrasound. Whenever ultrasound is a first test that is cheap and available, expertise is widely disseminated. So ultrasound is almost always a good first choice. Sometimes the ultrasound is negative, or it finds a true abnormality that they can then work on, like gallstones, that is usually the end of the imaging need. Dr. Kent Yucel, MD. the next step is if they do find a problem with the bile ducts, that is where CT or MRCP can be helpful. MRCP can be the next step to more fully evaluate what the problem is with the bile ducts. What's causing the problem? Dr. Anton Titov, MD. Generally it is a matter of blockage. And what is causing the blockage of bile ducts? Dr. Anton Titov, MD. There is a invasive test called ERCP, Endoscopic Retrograde Cholangio Pancreatography. That diagnostic test is more definitive for the bile ducts. But ERCP is a very invasive test, ERCP requires endoscopy, it is expensive. ERCP has to be done in almost a hospital setting. Then MRCP, non-invasive MRI of bile ducts and pancreas, can be very helpful before we go to ERCP Endoscopic invasive study of bile ducts and pancreas. It helps to do CT or MRCP to identify what's wrong. In many cases you can prevent the need for ERCP. Dr. Anton Titov, MD. Is MRCP an opportunity to screen for pancreatic or liver cancers, both of which are known to be very deadly? Dr. Anton Titov, MD. Dr. Kent Yucel, MD. No, with one exception. Pancreatic cancer is very deadly, it is also very fast growing. Pancreas is another area where there are benign lesions and benign cysts in the pancreas. So screening (by MRCP) does find a lot of unimportant insignificant benign lesions in the pancreas. When they are small, again, we rarely know whether they are significant or not. So we end up following patients for many years to prove they are not growing. But unfortunately, time window is short to find pancreatic cancer between the time it is detectable by MRI and the time it has grown to the size when we would have found it anyway. So doing CT or MRI every year will not detect the cancers in time to do anything about them. So screening is unlikely to do better than we would have done by just normal physical exam and normal medical care. Anton Titov, MD. So screening for pancreatic cancer although it is a terrible disease, and we'd love to find a way to prevent it, is not helpful. The one area where MRI is helpful in screening is in patients who have liver cirrhosis or fibrosis of the liver ( or fatty liver disease). They can be due to alcoholism, it can be due to viral disease, hepatitis B or hepatitis C. These patients are at significant risk of getting liver cancer. Ultrasound as well as liver MRI / MRCP are used to screen those patients annually to look for early liver cancer. Dr. Kent Yucel, MD. We can often find liver cancer in those patients at early enough stage to treat them and cure the cancer. So this one exception for screening for liver and pancreatic disease by MRCP. But it is screening not in normal patients, but in patients with underlying liver disease is MRI and ultrasound screening. MRI of liver and pancreas. MRCP vs. ERCP Video interview with leading expert in radiology, CT and MRI specialist. What are indications for MRCP, MRI and ERCP? Dr. Anton Titov, MD.