MRCP is the 'gold standard' for PSC diagnosis

MRCP (Magnetic resonance cholangiopancreatography) is a type of MRI scan:

  • cholang’ refers to the bile ducts
  • ‘pancreato’ refers to the pancreas
  • ‘gram’ refers to a type of X-ray/imaging

So in other words, it is a long-winded term for MRI imaging of your bile ducts and pancreas.

Magnetic resonance imaging (MRI) uses a strong magnetic field and radio waves to produce images of the inside of your body. MRI scanning is one of the safest imaging techniques available; it is non-invasive, painless and does not contain any ionising radiation.

MRCP is used to look at the biliary tree and is considered the ‘gold standard’ in diagnosing PSC and monitoring changes in the bile ducts over time 129. This is an important test in PSC, but can be difficult to interpret, especially if the picture is blurry because of any movement during the scan. Experts from the international PSC study group (IPSCSG) recommend patients should be assessed in experienced centres which include the performance and interpretation of MRI 129. They also recommend that patients unable to travel to specialty centres should have their MRI/MRCP images and clinical course reviewed by multidisciplinary teams with experience in PSC diagnosis and treatment 129.

It is important to wait to speak with your PSC doctor following an MRCP, because this test alone does not give a full picture of what’s going on. Your doctor looks at the MRCP in combination with your medical history, blood and other test results.

There is no agreed frequency for MRCPs in the management of PSC but you should have an MRCP if you have new or changing symptoms or evolving abnormalities in laboratory investigations: BSG/UK-PSC Guidelines Recommendation 11 58,

What happens during an MRCP scan?

You will usually be asked to restrict eating and drinking before your MRI scan. Please follow any instructions you are given carefully.

  1. Before your scan, you will be asked to remove all metal objects. This includes earrings and piercings, zips, belts, glasses and underwired bras. MRCP cannot be performed if you have had a cardiac pacemaker inserted, although there are now new MRI compatible devices now.
  2. You will enter the scanning room and you will see a large tube-shaped machine. This is the scanner. You will be asked to lie on the bed part, and you will be positioned correctly and secured in place. Make sure you ARE comfortable, because you have to lie in the same position for some time. Some people find it helpful to have a pillow placed under their feet.
  3. You will sometimes be given an injection (called contrast) just before you are moved into the scanner. If this is the case, you may need to lie on your back with your arms behind your head. Again, make sure you are comfortable. You might need a cushion or support under your elbows. An injection will only be given if the doctors want an MRI of your liver in addition to an MRCP.
  4. Once you are ready, the staff will place a communication buzzer in your hand and tell you how to use it.
  5. They then move the bed into the MRI scanner, which is like a short tunnel. Your head will be inside the MRI scanner and this can make some people feel claustrophobic. If you think this is likely to happen it is a good idea to close your eyes as you enter the scanner and keep them closed throughout.
  6. The staff then leave the room and communicate with you through speakers and a microphone in the scanner. You will be able to speak to and hear the staff at all times.

You can use the communication buzzer at any time to signal to the staff that you want to be removed. The scanner is very noisy but is completely painless.

Part of the scan involves lying very still. At some points, you are asked to hold your breath for a little while so they can get perfect images.

An MRI scan takes around 30 minutes. Some hospitals play music for your while you are in the scanner.

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