The main MRCP protocol in Greek hospitals and private facilities includes Τ2W SSFSE thin slice or/and thick slab and T2W 3D FSE sequences. In  addition to the basic protocol, other sequences such as 2D T2W FSE, T1W spoiled GE in phase / out phase, fully rewound GE, DWI, FSE variable flip angle and Driven equilibrium FSE are used. Furthermore, the majority does not administrate oral contrast media before the examination, which reduces the signal intensity of overlapping fluid.

After performing a t-test, the null hypothesis " Τhere is none of coincidence in the protocols which are used for MRCP examination", was rejected due to the probability value (p<0,001). Consequently, the alternative hypothesis was accepted, since these sequences T2W SSFSE thin slices, T2W thick slab and 3D FSE, exist as a basic trunk in the protocols and are used by the majority of the participants. The results demonstrate that there is a high statistical significance and thus it is concluded that the concrete sequences above reflect the population characteristics.

Additionally, fully rewound (BSSFP) is a quite frequent sequence, as well as T1W sequence which have been joined by several participants in their routine protocol. 2D and 3D b-SSFP acquisitions are useful alternative MRCP techniques [2]. The addition of T1-weighted gradient-echo in-phase images in MRCP protocol is considered to provide sufficient evidence about the nature of the filling defects seen on T2-weighted sequences as well as better discrimination of biliary air [1].

Moreover, our results show that 2D T2W FSE is also used in some protocols. Furthermore, regarding DWI, even though there are those who support [8] the routine addition of DWI to standard MRCP protocols, in our study it is used by a very small percent of the participants (p<0,001). FSE variable flip angle, is used less frequently in a routine protocol, a fact that is in contrast with those who recommend replacing the conventional 3D-TSE sequence with an optimized 3D-SPACE sequence [7].

 Although, Contrast Enhanced (CE) MRCP is considered to meliorate diagnostic capacity in some clinical cases (5) our survey demonstrates that it is performed only by a few, while functional MRCP (Secretin enhanced MRCP), which is referred to be a useful examination (6), isn’t implemented at all.

Even though, our study has a relatively small sample, which is a limitation, by taking into consideration the p value, it is given a reasonable evidence to support that our results can be considered as representative for the greater public, only for the three main sequences, T2W SSFSE with thin slices, T2W SSFSE thick slab and 3D FSE and thus can be generalized for hospitals and diagnostic centres in Greece

It is concluded that although protocols of magnetic resonance cholangiopancreatography (MRCP) which were recorded in Athens vary, the main MRCP protocol performed by many hospitals in Athens consists of T2w SSFSE thin slice, T2w SSFSE thick slab and 3D FSE sequences. Also, it is observed that T1w sequences as well as b-SSFP are used but less frequently than the main sequences.

This recording makes it possible to critically evaluate the protocols which are implemented and investigate which ones need additions and/or changes in order to improve diagnostic accuracy of the examination. Even though there is no consensus for the complete protocol of MRCP there is evidence that there is consensus at least for the main part of it. This fact may suggest that we are on the right tack of concluding about the MRCP protocol in the future.