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MR Cholangiopancreatography: Improved Ductal Distention with Intravenous Morphine Administration¹

¹ From the Department of Diagnostic Radiology, Mayo Clinic Scottsdale, 13400 E Shea Blvd, Scottsdale, AZ 85259 (A.C.S., A.K.H., P.T.L.); and Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester, Minn (J.L.F.). Presented as an education exhibit at the 2002 RSNA scientific assembly. Received March 31, 2003; revision requested May 13; revision received July 31 and accepted August 5. All authors have no financial relationships to disclose. Address correspondence to A.C.S. (e-mail: silva.alvin@mayo.edu).

Magnetic resonance (MR) cholangiopancreatography has proved a robust and noninvasive imaging modality for evaluating the biliary and pancreatic ducts without the use of ionizing radiation. Although MR cholangiopancreatography reliably depicts the main extrahepatic and intrahepatic bile ducts, it does not depict the segmental intrahepatic ducts unless they are dilated. The segmental ducts are difficult to visualize with MR cholangiopancreatography because of their small caliber and the limited spatial resolution and signal-to-noise ratio achievable with standard MR pulse sequences. However, visualization of the normal (ie, nondistended) biliary system is necessary for the evaluation of donor candidates for living related liver transplantation. Because of the prevalence of variant biliary anatomy, MR cholangiopancreatography is often used for preoperative evaluation of prospective liver donors. Intravenous morphine administered prior to MR cholangiopancreatography can improve image quality by causing the sphincter of Oddi to contract, which increases pressure in and distention of the biliary and pancreatic ducts. Morphine administration may also be particularly helpful for the evaluation of patients with primary sclerosing cholangitis, malignant neoplasms such as cholangiocarcinoma, or cystic and non–organ-deforming benign pancreatic neoplasms.

© RSNA, 2004

Index Terms: Bile ducts, MR, 76.121411, 76.92 • Liver, transplantation, 76.92, 774.92 • Magnetic resonance (MR), cholangiopancreatography, 76.121411, 774.121411, 76.12143, 774.12143 • Neoplasms, MR, 76.321, 774.312, 774.321 • Pancreas, MR, 774.121411, 774.12143, 774.92

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