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In our institution, we use a standard MRI and MRCP protocol for all pancreas examinations with gadolinium‐based intravenous contrast using a power injection, unless contraindicated by impaired renal function or contrast allergy. Prior to MRI examination, fasting for four to six hours reduces fluid in the stomach and decreases bowel peristalsis, both of which can cause overlying increased T2‐weighted signal that may obscure the pancreatic duct. A negative contrast agent consisting of 100–150 ml of superparamagnetic iron oxide particles can be given orally just before the examination to eliminate overlying fluid signal in the stomach and proximal small bowel segments.

We use either 1.5‐ or 3‐T MRI scanners for standard pancreas imaging. After obtaining localization sequences, pre‐contrast axial dual echo T1‐weighted GRE images with slice thickness of 6 mm are obtained to identify fatty changes, hemorrhage, and inflammation. Next, axial and coronal T2‐weighted nonfat‐suppressed breath‐hold sequences with 4‐mm slice thickness are used to identify biliary and pancreatic ductal anatomy, gallbladder, and pancreatic fluid collections. Axial fat‐suppressed T2‐weighted images are used to evaluate for pancreatic inflammation, fluid collections, and necrosis.

MRCP sequences include a three‐dimensional respiratory or a navigator‐triggered sequence, and provide high‐resolution images of the pancreatic and biliary ducts, side branches, and ductal anomalies. For secretin‐enhanced images, two‐dimensional MRCP images using a 40‐mm slab oriented with the longest axis of the main pancreatic duct are obtained.

We frequently use synthetic secretin when imaging patients with pancreatitis, although we avoid using secretin on those patients with early acute pancreatitis [7]. Secretin enhancement improves visualization of the main pancreatic duct and its anomalies such as pancreas divisum and subtle ductal stricture, and allows qualitative evaluation of pancreatic exocrine function. Coronal thick slab MRCP images are obtained after one minute intravenous administration of secretin 0.2 μg/kg. MRCP images are acquired every 30 seconds for 10 minutes. The peak effect of secretin is seen four to five minutes after administration [5] (Table 6.1).