MRCP — secretin-enhanced
Pancreatic duct along its whole length with the common bile duct, plus the duodenum for the fluid-filling response.
Typical, not policy
Timings, volumes and delays here are representative values drawn from published guidance. Scanner generation, injector, cardiac output and local preference all move them. Confirm against your department's own protocol before you rely on a number.
When to use it
- Suspected pancreas divisum or other ductal anatomical variant.
- Recurrent acute pancreatitis of unexplained cause.
- Suspected sphincter of Oddi dysfunction or papillary stenosis.
- Chronic pancreatitis where side-branch disease and exocrine reserve are in question.
- Suspected pancreatic duct leak or disruption, including after trauma or surgery.
- Establishing whether a cystic lesion communicates with the duct.
Technique
- Single thick-slab heavily T2-weighted images covering the pancreatic duct repeated approximately every 30 seconds for around 10 minutes from secretin administration.
- Duodenal filling grade over the series is used as a semiquantitative index of exocrine response.
- The standard MRCP dataset, including the 3D acquisition, is completed first.
- Dosing schedules and the exact repetition interval vary between published protocols and between centres.
Where it goes wrong
- Acquiring the 3D volumetric dataset after secretin, when small-bowel fluid obscures the ducts.
- Sampling interval too long, so the peak of duct distension is missed.
- Interpreting duct calibre changes without a baseline pre-secretin acquisition for comparison.
- Using secretin routinely for a straightforward stone question, where it adds cost and time without benefit.
Contrast
None
Synthetic secretin given intravenously at a weight-based dose, with imaging repeated at short intervals for roughly 10 minutes afterwards. Secretin is a pharmacological stimulant, not an imaging contrast agent.
- Baseline 3D imaging should be completed before secretin, because the induced duodenal fluid degrades the volumetric dataset.
Acquisition
- Breathing
- Repeated breath-hold thick-slab acquisitions at fixed intervals.
- Reconstruction
- A time series of coronal-oblique thick slabs, reviewed as a sequence to show duct distension and duodenal filling.
- Preparation
- Fast for approximately 4-6 hours: a contracted gallbladder and fluid-filled stomach both degrade the study. Confirm the local interval. Negative oral contrast (for example pineapple or blueberry juice) is often given to suppress overlying gastric and duodenal fluid. MRCP does not require gadolinium; add it only when the question includes a mass, inflammation or vascular assessment.
Safety checks this protocol carries
Derived from the contrast agent and phases above, not authored here — which is why they cannot drift apart from what the protocol actually does.
- MR safety screening for implants and foreign bodies· radiographer at scan