MRI Abdomen Without and With IV Contrast With MRCP Abdominal US is typically the first-line imaging modality; however, in the setting of persistently elevated ALP and a negative abdominal sonogram, MRI abdomen without and with IV contrast with MRCP may be useful. Sustained elevation of ALP is significantly correlated with choledocholithiasis on MRCP and may be helpful for triaging patients to endoscopic retrograde cholangiopancreatography (ERCP); however, patients who have common bile duct stones demonstrated on US should proceed directly to ERCP [64,65]. If extra- or intrahepatic biliary ductal dilatation is identified on abdominal US, contrast-enhanced MRI with MRCP is the most useful imaging modality for evaluating the etiology of biliary obstruction. Contrast-enhanced MRI with MRCP facilitates noninvasive evaluation of both intra- and extrahepatic bile ducts, as well as the liver parenchyma [66]. Further, contrast-enhanced MRI with MRCP enables triaging of patients to subsequent interventions, such as stenting with ERCP, brushings by endoscopic US, and image-guided or laparoscopic biopsy, as well as serving as a guide for the subsequent approach with these interventions. MRI performed with diffusion sequences and hepatobiliary contrast agents can be advantageous in lesion detection and characterization, although a decreased uptake of hepatobiliary agents by hepatocytes might decrease diagnostic accuracy, especially in patients with reduced liver function [51]. MRI Abdomen Without IV Contrast With MRCP Although less sensitive than contrast-enhanced MRI, a noncontrast MRI (including MRCP) may be useful for identifying biliary obstruction as a source of cholestasis. Contrast administration improves the sensitivity for detection of acute cholangitis, hepatic metastases, and the detection of primary sclerosing cholangitis.
Abnormal Liver Function Tests. MRI Abdomen Without and With IV Contrast With MRCP Abdominal US is typically the first-line imaging modality; however, in the setting of persistently elevated ALP and a negative abdominal sonogram, MRI abdomen without and with IV contrast with MRCP may be useful. Sustained elevation of ALP is significantly correlated with choledocholithiasis on MRCP and may be helpful for triaging patients to endoscopic retrograde cholangiopancreatography (ERCP); however, patients who have common bile duct stones demonstrated on US should proceed directly to ERCP [64,65]. If extra- or intrahepatic biliary ductal dilatation is identified on abdominal US, contrast-enhanced MRI with MRCP is the most useful imaging modality for evaluating the etiology of biliary obstruction. Contrast-enhanced MRI with MRCP facilitates noninvasive evaluation of both intra- and extrahepatic bile ducts, as well as the liver parenchyma [66]. Further, contrast-enhanced MRI with MRCP enables triaging of patients to subsequent interventions, such as stenting with ERCP, brushings by endoscopic US, and image-guided or laparoscopic biopsy, as well as serving as a guide for the subsequent approach with these interventions. MRI performed with diffusion sequences and hepatobiliary contrast agents can be advantageous in lesion detection and characterization, although a decreased uptake of hepatobiliary agents by hepatocytes might decrease diagnostic accuracy, especially in patients with reduced liver function [51]. MRI Abdomen Without IV Contrast With MRCP Although less sensitive than contrast-enhanced MRI, a noncontrast MRI (including MRCP) may be useful for identifying biliary obstruction as a source of cholestasis. Contrast administration improves the sensitivity for detection of acute cholangitis, hepatic metastases, and the detection of primary sclerosing cholangitis.