Background:
Magnetic resonance cholangiopancreatography (MRCP) is a well-established, non-invasive technique for imaging the biliopancreatic ductal system. Conventional three-dimensional free-breathing MRCP (FB-MRCP) provides high spatial resolution but is limited by long acquisition times and susceptibility to respiratory motion artifacts. Compressed sensing (CS) allows accelerated MRI acquisition while maintaining diagnostic image quality.

Methods:
In this prospective study, 50 patients (31 female, 19 male; mean age 54.5 ± 15 years) underwent MRCP at 1.5 T. Conventional FB-MRCP was compared with two CS-based sequences: free-breathing CS-MRCP (FB-CS-MRCP) and breath-hold CS-MRCP (BH-CS-MRCP). All sequences were acquired as isotropic 3D T2-SPACE images with 1-mm slice thickness. Two independent radiologists assessed image quality, artifacts, background suppression, visualization of biliopancreatic anatomy, and depiction of pathological findings using a 5-point Likert scale. Acquisition times and interreader agreement (Cohen’s kappa) were analyzed.

Results:
Mean acquisition times were 6:00 min for FB-MRCP, 4:10 min for FB-CS-MRCP, and 19 s for BH-CS-MRCP. FB-CS-MRCP demonstrated image quality and anatomical visualization comparable to conventional FB-MRCP (all p > 0.05) while reducing acquisition time by approximately 33%. BH-CS-MRCP showed significantly reduced overall image quality compared with FB-MRCP (p < 0.05) and increased motion sensitivity, although artifact and background suppression were superior to FB-CS-MRCP. Diagnostic assessment of lesions, cysts, and stenoses did not differ significantly between sequences.

Conclusion:
FB-CS-MRCP is a reliable and time-efficient alternative to conventional FB-MRCP, offering significant acceleration without loss of diagnostic performance. BH-CS-MRCP provides ultra-fast acquisition but shows greater variability in image quality and is best suited as a complementary sequence.