title: Does secretin-stimulated MRCP predict exocrine pancreatic insufficiency?: A comparison with noninvasive exocrine pancreatic function tests.
abstract: BACKGROUND
  Data on magnetic resonance cholangiopancreatography with secretin stimulation (S-MRCP) for the assessment of exocrine pancreatic insufficiency (EPI) are limited. We compared pancreatic function tests with the findings of S-MRCP in patients with chronic pancreatitis (CP) and disease controls.
  
  
  METHODS
  S-MRCP was performed in 23 patients (18 CP, 5 disease controls). MRCP images were analyzed for secretin-induced duodenal liquid filling (0=no filling; 1=duodenal bulb; 2=up to lower flexure; 3=beyond lower flexure). EPI was evaluated by fecal elastase, fecal fat concentration, and a 13C mixed chain triglyceride breath test. Clinically relevant EPI was stated if 2 of 3 tests were pathologic.
  
  
  RESULTS
  EPI was diagnosed in 10 of 18 patients with CP. Patients without EPI showed either grade 2 (n=4) or grade 3 (n=9) duodenal filling, whereas only 1/10 patients with EPI showed grade 3 duodenal filling. Sensitivity and specificity of S-MRCP for the diagnosis of EPI were 69% and 90%, respectively.
  
  
  CONCLUSIONS
  Assessment of duodenal filling should be performed in patients who undergo S-MRCP for the evaluation of pancreatic morphology. However, minor degrees of duodenal filling are equivocal and require further diagnostic evaluation.
authors.affiliation: Medical Department I-ZAFES, Johann Wolfgang Goethe-University Frankfurt am Main, Germany. arne.schneider@em.uni-frankfurt.de
authors.forename: Arne R J
authors.initials: AR
authors.lastname: Schneider
authors.forename: Renate
authors.initials: R
authors.lastname: Hammerstingl
authors.forename: Matthias
authors.initials: M
authors.lastname: Heller
authors.forename: Nada
authors.initials: N
authors.lastname: Povse
authors.forename: Lydia
authors.initials: L
authors.lastname: Murzynski
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Vogl
authors.forename: Wolfgang F
authors.initials: WF
authors.lastname: Caspary
authors.forename: Juergen
authors.initials: J
authors.lastname: Stein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D049448:Cholangiopancreatography, Magnetic Resonance; D010188:Exocrine Pancreatic Insufficiency / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D005765:Gastrointestinal Agents; D006801:Humans; D008297:Male; D008875:Middle Aged; D010186:Pancreatic Function Tests / Q000379:methods*; D050500:Pancreatitis, Chronic / Q000175:diagnosis* / Q000503:physiopathology; D012633:Secretin
chemical_list: D005765:Gastrointestinal Agents; D012633:Secretin