Idiopathic chronic pancreatitis in children: MR cholangiopancreatography after secretin administration.
OBJECTIVE
To assess the accuracy of dynamic magnetic resonance (MR) cholangiopancreatography after secretin administration in detecting pancreatic duct abnormalities typical of early-onset idiopathic chronic pancreatitis in children with recurrent episodes of idiopathic acute pancreatitis.


METHODS
Fifteen children (mean age, 11.3 years; range, 6-17 years) with at least three recurrent episodes of idiopathic acute pancreatitis prospectively underwent MR cholangiopancreatography before and after secretin administration. Image analysis included visualization of side branches, ductal narrowing, endoluminal filling defects, irregular ductal contour, cavities, and pancreas divisum. All patients underwent endoscopic retrograde cholangiopancreatography (ERCP).


RESULTS
Dilated side branches were detected in three (20%) of 15 patients on MR cholangiopancreatograms obtained before secretin administration and in seven (47%) of 15 patients on images obtained after secretin administration. Ductal narrowing was detected in one (7%) of 15 patients on images obtained before secretin administration and in two (13%) of 15 patients on images obtained after secretin administration. Endoluminal filling defects in one (7%) of 15 patients were observed on MR cholangiopancreatograms obtained both before and after secretin administration. Irregular contour of the main pancreatic duct was present in four (27%) of 15 patients on MR cholangiopancreatograms obtained before secretin administration and in five (33%) of 15 patients on images obtained after secretin administration. Cavities and pancreas divisum were detected in one (7%) of 15 patients and in two (13%) of 15 patients, respectively, only on MR cholangiopancreatograms obtained after secretin administration.


CONCLUSIONS
Secretin improves the sensitivity of MR cholangiopancreatography in diagnosing early-onset idiopathic chronic pancreatitis.
Department of Radiology, A. Gemelli University Hospital, 8 Largo A. Gemelli, Rome 00168, Italy. rmanfredi@rm.unicatt.it
Riccardo
R
Manfredi
Vincenzina
V
Lucidi
Benedetta
B
Gui
M Gabriella
MG
Brizi
Amorino
A
Vecchioli
Giulia
G
Maresca
Luigi
L
Dall'Oglio
Guido
G
Costamagna
Pasquale
P
Marano
D000293:Adolescent; D001652:Bile Ducts / Q000473:pathology*; D002648:Child; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002908:Chronic Disease; D006801:Humans; D008279:Magnetic Resonance Imaging; D010179:Pancreas / Q000473:pathology*; D010195:Pancreatitis / Q000175:diagnosis*; D011446:Prospective Studies; D012008:Recurrence; D012633:Secretin; D012680:Sensitivity and Specificity
D012633:Secretin