cancer treatment in japan MRI of Liver and Pancreas: When to Have MRCP or ERCP? (9)

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Professor Dr. Kent Yucel MD, prominent MRI and CT expert and interventional radiologist with particular focus on heart disease diagnosis by MRI and CT Angiography, and treatments by minimally invasive interventional radiology methods, and Dr. Anton Titov MD / Exclusive interview

- 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. If someone has a known or suspected problem in liver, pancreas or bile ducts, when would they benefit from MRCP [MRI of liver] and what should they expect? The hepatobiliary system is primarily evaluated by ultrasound, similar to the heart situation, where 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. If the ultrasound is negative, or it finds a clear abnormality that they can then work on, like gallstones, that's usually the end of the imaging need. I think the next step is - if they do find a problem with the bile ducts, that's where CT or MRCP can be helpful as the next step to more fully evaluate what's causing the problem with the bile ducts. Generally it's a matter of blockage. What is causing the blockage of bile ducts? There is invasive test called ERCP, Endoscopic Retrograde Cholangio Pancreatography. ERCP is a more definitive test for the bile ducts. But ERCP is a very invasive test, ERCP requires endoscopy, it's expensive. ERCP has to be done in almost a hospital setting. It can be very helpful - before we go to ERCP

- to do CT or MRCP to identify what's wrong. It can prevent the need for ERCP. Is MRCP an opportunity to screen for pancreatic or liver cancers, both of which are known to be very deadly? 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 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, 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 - this time is short. So doing CT or MRI every year will not detect the cancers in time to do anything about them. It will not be better than just doing normal physical exam and normal medical care. So screening for pancreatic cancer, although it's 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 people who have liver cirrhosis or fibrosis of the liver. It can be due to alcoholism, it can be due to viral disease, hepatitis B or hepatitis C. These people are at significant risk of getting liver cancer. Ultrasound as well as liver MRI / MRCP are used to screen those people annually to look for early liver cancer. We can often find liver cancer in those patients at early enough stage to treat them and cure the cancer. So this is one exception for screening for cancer - not in normal people, but in people with underlying liver disease is MRI or ultrasound screening.

cancer treatment in japan MRI of Liver and Pancreas: When to Have MRCP or ERCP? (9)
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