title: Pancreas divisum and santorinicele: assessment by dynamic magnetic resonance cholangiopancreatography during secretin stimulation.
abstract: OBJECTIVE
  To evaluate the usefulness of MRCP, before and after secretin administration, in diagnosing Santoriniceles in patients with pancreas divisum.
  
  
  METHODS
  One hundred and eight patients with suspected pancreatic disease, underwent dynamic magnetic resonance cholangiopancreatography (MRCP) before and after secretin administration (S-MRCP). S-MRCP images were evaluated for presence/absence of pancreas divisum, Santorinicele; size of the main pancreatic duct and of the Santorinicele. The onset of duodenal filling was calculated on dynamic S-MRCP images. S-MRCP findings were compared to endoscopic retrograde cholangiopancreatography (ERCP) ones (39/108).
  
  
  RESULTS
  Pancreas divisum (PD) was detected in 6/108 patients (6%) at MRCP, and in 16/108 patients (14%) at S-MRCP. ERCP confirmed the diagnosis in 12/16 patients, with 1 false positive. 3 patients did not undergo ERCP. Santorinicele was detected in 4/108 (3%) patients at MRCP and in additional 4/108 (3%) patients at S-RMCP, only in patients with PD. Santoriniceles were confirmed in 7/8 patients at ERCP; in 1/8 patient CPRE was unsuccessful. The duct of Santorini was significantly larger (p< 0.05), in the pancreatic head, in patients with PD and Santorinicele (3.6 mm) compared to those with PD only (2.2 mm). A significant reduction in size of the pancreatic duct (26%) and of the Santorinicele (63%) was observed after sphincterotomy. The onset of duodenal filling was significantly delayed in patients with Santorinicele (2.1 vs 1.3 minutes)(p<0.05).
  
  
  CONCLUSIONS
  S-MRCP helps to identify patients with pancreas divisum and Santorinicele, a known cause of impeded pancreatic outflow which benefits from endoscopic treatment.
authors.affiliation: Istituto di Radiologia, Università Cattolica del Sacro Cuore A. Gemelli, Rome, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Manfredi
authors.forename: Maria Gabriella
authors.initials: MG
authors.lastname: Brizi
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna
authors.forename: Gabriele
authors.initials: G
authors.lastname: Masselli
authors.forename: Amorino
authors.initials: A
authors.lastname: Vecchioli Scaldazza
authors.forename: Pasquale
authors.initials: P
authors.lastname: Marano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000002:abnormalities*; D010183:Pancreatic Ducts / Q000473:pathology*; D012633:Secretin
chemical_list: D012633:Secretin