CT/MRI Hepatobiliary & Pancreas
CT/MRINICE NG852018NICE NG1042018, updated 2020NICE CG1882014EASL Clinical Practice Guidelines (2018)RCR iRefer2017, continuously updatedv2.0 · March 2026
Varies
OutpatientInpatient
All imaging requests must be justified by an IR(ME)R practitioner (radiologist or radiographer)Pancreatic cancer (NG85)
— ANY of the following
- Pancreatic protocol CT BEFORE draining bile duct for obstructive jaundiceNICE NG85 Rec 1.1.1
- Pancreatic protocol CT for pancreatic abnormalities without jaundiceNICE NG85 Rec 1.1.4
- CT CAP for newly diagnosed pancreatic cancerNICE NG85 Rec 1.3.1
- FDG PET-CT for localised disease receiving treatmentNICE NG85 Rec 1.3.2
- Pancreatic protocol = arterial + portal venous, thin-section
Acute pancreatitis (NG104)
NG104 focuses on management, NOT diagnosis — guideline gap. UK practice: CT at 48–72 hours for severity/complications. Early CT (<48 hours) may underestimate necrosis.
- NG104 focuses on management, NOT diagnosis — guideline gap for imaging indicationNICE NG104
- UK practice: CT at 48–72 hours for severity assessment and complications
- Early CT (<48 hours) may underestimate necrosis
Bile duct stones — MRCP (CG188)
— ANY of the following
- Consider MRCP if USS shows no CBD stones but duct dilated and/or LFTs abnormalNICE CG188 Rec 1.1.2
- Consider EUS if MRCP non-diagnosticNICE CG188 Rec 1.1.3
Liver lesion characterisation
— ANY of the following
- No standalone NICE guideline — RCR iRefer (guideline gap)
- Contrast-enhanced MRI with hepatobiliary agent (gadoxetic acid/Primovist) gold standard
- LI-RADS classification for at-risk patients
- EASL Clinical Practice Guidelines 2018 for HCCEASL 2018
Notes
Information
Pancreatic protocol = arterial + portal venous phase, thin-section
Information
MRI with hepatobiliary contrast agent gold standard for liver lesions
Warning
Early CT in pancreatitis (<48 hours) may underestimate necrosis
Guideline Corrections
NG188 → CG188 (2014)
References to 'NG188' for gallstone disease are incorrect — correct is CG188
Change Log
v2.02026-03-08New protocol — hepatobiliary and pancreatic imaging consolidated