Severe chronic pancreatitis versus suspected pancreatic disease: dynamic MR cholangiopancreatography after secretin stimulation.
OBJECTIVE
To assess whether secretin stimulation improves visualization of the pancreatic ducts at magnetic resonance (MR) cholangiopancreatography (MRCP) in patients with severe chronic pancreatitis or suspected pancreatic disease.


METHODS
Thirty-one patients (group 1) with chronic pancreatitis and 84 patients (group 2) with clinical and/or laboratory findings suggestive of pancreatic disease who did not have ductal alterations at ultrasonography (US) and/or computed tomography (CT) underwent MRCP before and up to 10 minutes after secretin stimulation. Size of the main pancreatic duct (head, body, tail) and duodenal filling before and after secretin stimulation were measured quantitatively. Image quality, number of main pancreatic ductal segments visualized, visualization of side branches, ductal narrowing, endoluminal filling defects, and presence of pancreas divisum were analyzed qualitatively.


RESULTS
In both groups, the size of the main pancreatic duct increased significantly 3 minutes after secretin stimulation. Reduced duodenal filling was detected in patients with severe chronic pancreatitis (P < .001). The number of segments of the main pancreatic duct visualized improved from 85 (91%) to 93 (100%) of 93 in group 1 and from 164 (65%) to 245 (97%) of 252 (P < .001) in group 2. Visualization of side branches improved from 22 (71%) to 31 (100%) of 31 in group 1 and from three (4%) to 53 (63%) of 84 (P < .001) in group 2. Pancreas divisum was visualized in one additional patient in group 1 and in six additional patients in group 2.


CONCLUSIONS
The administration of secretin improves visualization of the pancreatic ducts and helps in the evaluation of exocrine reserve.
Manfredi
R
R
Department of Radiology, A. Gemelli University Hospital, Rome, Italy. rmanfredi@rm.unicatt.it
Costamagna
G
G
Brizi
M G
MG
Maresca
G
G
Vecchioli
A
A
Colagrande
C
C
Marano
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000002:abnormalities / Q000473:pathology; D010182:Pancreatic Diseases / Q000175:diagnosis*; D010183:Pancreatic Ducts / Q000473:pathology; D010186:Pancreatic Function Tests; D010195:Pancreatitis / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012633:Secretin; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D012633:Secretin