Background: Biliary tract diseases encompass a wide range of conditions, including cholelithiasis, choledocholithiasis, biliary strictures, malignancies, and other hepatopancreatic abnormalities. Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive magnetic resonance imaging technique that provides detailed visualization of the biliary and pancreatic ductal systems without the use of ionizing radiation. Retrospective evaluation of MRCP findings can help determine the distribution of biliary pathologies and their association with biliary obstruction. 

Aim: To retrospectively evaluate the spectrum and frequency of biliary tract pathologies detected on MRCP and their association with biliary obstruction. 

Materials and Methods: A retrospective observational study was conducted at Max Super Speciality Hospital, Noida, Uttar Pradesh, including 40 patients who underwent MRCP between January 2026 and June 2026. Demographic, clinical, and imaging findings were obtained from available medical records and MRCP reports and images. Patients were categorized into obstructive and non-obstructive groups for exploratory analysis. The Mann-Whitney U test was used to compare CBD diameter, while associations between obstruction and intrahepatic biliary radical (IHBR) dilatation and jaundice were assessed using the Chi-square and Fisher’s exact tests, respectively. A p-value <0.05 was considered statistically significant. Institutional Ethics Committee approval was obtained. 

Results: The mean age was 51.93 ± 17.02 years, with females comprising 65% of the study population. Stone-related pathology was the most common finding (55%). Biliary obstruction was identified in 27.5% of patients. Mean CBD diameter was significantly higher in obstructive cases (11.23 ± 5.34 mm) than in non-obstructive cases (6.06 ± 3.80 mm; p=0.002). IHBR dilatation was also significantly associated with obstruction (81.8% vs. 37.9%; p=0.013).

Conclusion: MRCP effectively demonstrated a wide spectrum of biliary tract abnormalities. CBD and IHBR dilatation were significantly associated with biliary obstruction, supporting the role of MRCP in the evaluation of biliary diseases.