MRCP Report Template: Normal Study and Biliary Findings

MRCP reporting: scope and normal report template

Magnetic resonance cholangiopancreatography (MRCP) is a heavily T2-weighted MRI technique that depicts fluid-filled bile and pancreatic ducts. It is commonly interpreted together with anatomic T1- and T2-weighted sequences and, when indicated, contrast-enhanced images. State what was actually acquired: a noncontrast MRCP sequence set is not interchangeable with a complete contrast-enhanced liver or pancreatic MRI.

A useful report answers the clinical question by describing the gallbladder when present, the intrahepatic and extrahepatic bile ducts, the level and cause of any obstruction when visible, the main pancreatic duct, and relevant surrounding structures. Do not treat a normal-looking maximum-intensity projection (MIP) as proof that all source images are normal.

Examination: MRI of the abdomen including MRCP [without / without and with intravenous contrast].

Indication: [Clinical question, such as biliary dilatation, suspected duct stone, cholestatic laboratory results, or postoperative assessment.]

Comparison: [Date and modality, or none available.]

Technique and limitations: Multiplanar MRI with heavily T2-weighted 2D and/or 3D MRCP sequences and [additional T1-, T2-, diffusion-weighted, and postcontrast sequences as acquired]. [Describe motion, incomplete coverage, or other limitations.]

Findings:
Liver: [Visible parenchyma and relevant focal or diffuse findings.]

Gallbladder: [Present/absent; distention; stones or sludge; wall and surrounding tissues, within the acquired field.]

Bile ducts: [Intrahepatic ducts and right/left hepatic duct confluence.] Common hepatic duct measures [ ] mm and common bile duct measures [ ] mm at [level/measurement plane]. [No / describe] filling defect, focal narrowing, abrupt cutoff, or upstream dilatation. [State whether the distal duct and ampulla are adequately seen.]

Pancreatic duct and pancreas: Main pancreatic duct measures [ ] mm in the [head/body] and has [normal / described] course and caliber. [Describe the visualized pancreas and peripancreatic tissues.]

Postoperative anatomy: [Describe surgical clips, biliary-enteric anastomosis, stent, or altered anatomy if present.]

Impression:
1. [No biliary obstruction / level and likely imaging cause of obstruction.]
2. [Relevant gallbladder, pancreatic duct, or postoperative finding.]
3. [Important limitation, if it changes interpretation.]

Normal MRCP example

Fictional teaching example. The measurements below illustrate a report and are not universal thresholds. Interpret duct caliber in the context of age, prior cholecystectomy, symptoms, laboratory results, and the full examination.

Examination: MRI of the abdomen without and with intravenous contrast, including MRCP.

Indication: Intermittent right upper quadrant discomfort and mild cholestatic laboratory abnormalities.

Comparison: Right upper quadrant ultrasound dated [date].

Technique: Multiplanar MRI with axial and coronal T2-weighted images, heavily T2-weighted 2D and 3D MRCP sequences, diffusion-weighted imaging, and precontrast and multiphase postcontrast T1-weighted images. The biliary tree is adequately visualized. No significant motion limitation.

Findings:
The liver is normal in contour and signal on the acquired sequences. The gallbladder is present and adequately distended, without a filling defect or focal wall thickening. The intrahepatic ducts are not dilated. The common hepatic duct and common bile duct are smooth in contour; the common bile duct measures 5 mm at the midportion. No intraductal filling defect or abrupt narrowing is seen. The distal common bile duct and ampulla are visualized.

The main pancreatic duct is not dilated and measures 2 mm in the body. The pancreas has preserved morphology without a focal lesion or peripancreatic collection. No upper abdominal ascites is present.

Impression:
1. No biliary ductal dilatation or choledocholithiasis identified.
2. No pancreatic duct dilatation.

Use the example’s measurements only when they match the images and local measurement method. A duct diameter alone does not establish obstruction or exclude it.

Duct-by-duct review and reporting checklist

Gallbladder and cystic duct

• State whether the gallbladder is present, surgically absent, contracted, or incompletely visualized.
• Describe stones, sludge, focal wall abnormality, and surrounding fluid when seen.
• Avoid calling a contracted gallbladder normal if it limits assessment of its lumen or wall.
• Note a low-inserting or long cystic duct only when it is relevant to the question or could explain an apparent duct contour.

Intrahepatic and extrahepatic bile ducts

• Review the right and left hepatic ducts, their confluence, common hepatic duct, and common bile duct on source images and reformats.
• Describe dilatation by distribution: central or peripheral intrahepatic, extrahepatic, or both.
• Measure the duct at a reproducible location when a measurement answers the clinical question; name the segment or level. There is no single diameter threshold that should be applied without clinical and anatomic context.
• For a suspected stricture, give its level, length when measurable, contour, degree of upstream dilatation, and whether an obstructing mass is seen on the sequences acquired.
• For a filling defect, state its location, number, size if measurable, and relationship to the dependent duct lumen. Check thin-section source images rather than relying on the MIP alone.
• State if the distal duct, ampulla, or anastomosis is not adequately depicted.

Pancreatic duct and adjacent structures

• Review the main pancreatic duct through the head, body, and tail when visible. Describe focal caliber change, upstream dilatation, or an abrupt termination.
• Review pancreatic parenchyma and the ampullary region on the accompanying MRI sequences; MRCP-only slabs do not fully assess a pancreatic mass.
• Note relevant fluid collections, lymph nodes, or vascular findings within the actual examination scope.

Examination and comparison

• Identify the study as MRCP, with or without a broader contrast-enhanced abdominal MRI.
• State whether contrast was given and which additional sequences were obtained.
• Compare with prior imaging, especially for duct caliber, stricture length, anastomosis, or an indeterminate filling defect.
• If motion, susceptibility from clips or stents, or incomplete coverage obscures an area, state the affected segment and the consequence for interpretation.
• Keep the impression focused on the clinical question and the most actionable finding.

Selected abnormal and postoperative wording

Fictional example: distal common bile duct filling defect

The common bile duct measures 9 mm and contains a 4 mm dependent low-signal filling defect in its distal portion, visible on the thin-section source images. Mild upstream extrahepatic ductal dilatation is present. No pancreatic head mass is identified on the acquired sequences.
Impression: Distal common bile duct filling defect with mild upstream biliary dilatation, most consistent with choledocholithiasis. No pancreatic head mass is identified on this examination.

A small defect should be described only if it is visible on the source data and distinguishable from flow-related signal loss, pneumobilia, or partial-volume artifact. If the finding remains equivocal, say so and describe what limits confidence.

Fictional example: focal stricture

There is a short segment of smooth narrowing of the common hepatic duct just below the right-left hepatic duct confluence, with mild central intrahepatic ductal dilatation. No discrete mass is identified on the acquired sequences. The distal common bile duct is not dilated.
Impression: Short common hepatic duct stricture with mild upstream central intrahepatic ductal dilatation. No discrete obstructing mass is identified on this examination.

If contrast-enhanced sequences were not acquired or the cause is not shown, do not call a stricture benign or malignant from duct contour alone. State the site and extent, then tailor any recommendation for additional imaging or endoscopic assessment to the clinical context and local pathway.

Postoperative anatomy

The gallbladder is surgically absent. There is a [type, if known] biliary-enteric anastomosis at [site]. [Describe duct caliber above the anastomosis, filling defects, narrowing, and any upstream dilatation.] Evaluation of [segment] is limited by [artifact or incomplete coverage].
Impression: [State the postoperative finding and whether an anastomotic stricture or upstream obstruction is identified, not identified, or cannot be assessed.]

A postoperative duct can have altered anatomy and caliber. Identify the operation or anastomosis when known, compare with prior studies, and avoid describing a surgically absent gallbladder as nonvisualized.

Common pitfalls and limitations

• Reading only MIP images: Thick-slab or MIP reconstructions can obscure small filling defects and distort duct caliber. Review thin-section source images and the accompanying MRI sequences.
• Calling every low-signal focus a stone: Flow effects, air, clips, sludge, and partial-volume effects can mimic a filling defect. Describe the location and appearance and preserve uncertainty when needed.
• Overlooking the level of obstruction: “Biliary dilatation” alone is incomplete when the transition point or upstream distribution is visible.
• Using a diameter without context: Age, cholecystectomy, measurement level, and clinical context influence interpretation. State the measurement method and compare with prior imaging where useful.
• Calling the cause of a stricture from contour alone: MRCP can show the level and extent of narrowing, but routine MRCP may not determine its cause. Evaluate the full MRI and clinical context.
• Overstating a negative examination: Small stones, an impacted distal stone, subtle strictures, and regions obscured by motion or artifact may be missed. State a meaningful limitation.
• Treating MRCP as therapeutic imaging: MRCP is a diagnostic examination. It does not remove a stone or provide the therapeutic access of ERCP.

The ACR Appropriateness Criteria consider MRI with MRCP an appropriate imaging option in selected patients with jaundice or suspected obstruction. In patients at intermediate risk of choledocholithiasis, the ASGE guideline supports MRCP or endoscopic ultrasound as diagnostic options; the next step depends on the patient and local clinical pathway.

For whole-abdominal ultrasound reporting, see the normal complete abdominal ultrasound report. For a CT-based abdominal review structure, see the abdomen and pelvis CT reporting checklist.

References

• American College of Radiology. ACR–SAR–SPR Practice Parameter for the Performance of Magnetic Resonance Imaging (MRI) of the Abdomen (Excluding the Liver). PDF (opens in a new tab)
• American College of Radiology. ACR Appropriateness Criteria: Jaundice. Narrative (opens in a new tab)
• Ippolito D, Maino C, Arrivé L, et al. ESGAR consensus statement on MR imaging in primary sclerosing cholangitis. European Radiology. 2025;35(10):6495–6506 (PSC-specific consensus). Article (opens in a new tab)
• Buxbaum JL, et al. ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis. Gastrointestinal Endoscopy. 2019;89(6):1075–1105.e15. Guideline (opens in a new tab)

Educational note: This article is a reporting aid, not a diagnostic rule. Adapt the wording to the actual sequences, images, clinical question, and local protocol.