Pancreatic duct after pancreatoduodenectomy: morphologic and functional evaluation with secretin-stimulated MR pancreatography.
OBJECTIVE
The purpose of this study was to evaluate the usefulness of secretin-enhanced MR pancreatography in evaluating morphologic changes and pancreatic function after pancreatoduodenectomy.


METHODS
Twenty patients who underwent pancreatoduodenectomy were evaluated with secretin MR pancreatography. Single-shot fast spin-echo T2-weighted dynamic MR pancreatograms were obtained before and every minute for 10 min after secretin injection. Image analysis included image quality for the visualization of the pancreatic duct and morphologic features of the pancreatic duct (side branches, ductal narrowing, irregular ductal contour, and patency of the anastomotic site). Pancreatic function was assessed using the Van de Kamer method and the fasting blood glucose and oral glucose tolerance tests. Jejunal filling was graded from the lowest amount of filling (grade 1) to normal filling (grade 3) on the last MR pancreatogram.


RESULTS
The visualization of the main pancreatic duct was significantly improved with dynamic MR pancreatography (p < 0.05). The anastomotic site was visualized in 14 patients (70%) on MR pancreatography after secretin administration (p < 0.05). No statistically significant improvement in other morphologic data was seen after secretin administration. The sensitivity, specificity, positive predictive value, and negative predictive value of reduced jejunal filling (grade 1) for assessment of reduced pancreatic exocrine function were 92%, 71%, 85%, and 83%, respectively. The relation between reduced jejunal filling (grade 1) and diabetes was statistically significant (p < 0.05).


CONCLUSIONS
The administration of secretin improves visualization of the pancreatic ducts and helps in the evaluation of remnant pancreatic function after pancreatoduodenectomy.
Monill
Josep
J
Department of Radiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Antoni M. Claret 167, Barcelona 08025, Spain. jmonills@menta.net
Pernas
Juan
J
Clavero
Juan
J
Farré
Antonio
A
Morales
Antonio
A
González
Mario
M
Artigas
Vicente
V
Martínez-Noguera
Antonio
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D005260:Female; D052203:Ferrosoferric Oxide; D005951:Glucose Tolerance Test; D006801:Humans; D007089:Image Enhancement; D007501:Iron; D007583:Jejunum / Q000473:pathology / Q000502:physiology; D008279:Magnetic Resonance Imaging; D058185:Magnetite Nanoparticles; D008297:Male; D008875:Middle Aged; D010087:Oxides; D010179:Pancreas / Q000473:pathology*; D046790:Pancreas, Exocrine / Q000502:physiology; D010183:Pancreatic Ducts / Q000473:pathology*; D010186:Pancreatic Function Tests; D016577:Pancreaticoduodenectomy; D010195:Pancreatitis / Q000175:diagnosis; D011237:Predictive Value of Tests; D012633:Secretin; D012680:Sensitivity and Specificity; D012833:Siloxanes
D003287:Contrast Media; D058185:Magnetite Nanoparticles; D010087:Oxides; D012833:Siloxanes; D012633:Secretin; C088769:ferumoxsil; D007501:Iron; D052203:Ferrosoferric Oxide